Evaluation and management of the atrial fibrillation patient: a report from the Society of Cardiovascular Patient Care

Linking care of patients with obesity to outpatient weight control clinics following acute hospitalizations

Despite obesity impacting over one-third of US adults, guideline recommendations have not been effectively utilized by health care providers in hospital settings. Initiation of weight loss plans for obese patients during hospitalizations followed by linkage of care to weight control centers may improve compliance with the guidelines. Provider recognition and awareness that obesity is a chronic condition that warrants inpatient counsel and management with appropriate arrangement of postdischarge follow-up care will be critical to guideline implementation.

Posterior pericardiotomy in cardiac surgery: systematic review and meta-analysis

This systematic review with meta-analysis sought to determine the impact of posterior pericardiotomy on incidences of atrial fibrillation and supraventricular arrhythmias, pericardial effusion, pleural effusion, tamponade, and the length of hospital stay after cardiac surgery. We searched for randomized controlled trials, using Medline, Embase, Elsevier and Sciences online databases as well as Google Scholar literature. The effect sizes measured were odds ratio for categorical variables and standard mean difference with 95% confidence interval for calculating differences between mean values of hospital stay in intervention and control groups. A value of p < 0.1 for Q test or I2 > 50% indicated significant heterogeneity between the studies. The literature search of all major databases retrieved 20 studies. After screening, 12 suitable trials were identified, which reported outcomes of 2052 patients undergoing cardiac surgery. Posterior pericardiotomy had an odds ratio of 0.33 [95% confidence interval: 0.18–0.61] p < 0.001 for atrial fibrillation; odds ratio 0.32 [0.15–0.67] p = 0.003 for supraventricular arrhythmias; odds ratio 0.09 [0.04–0.19] p = 0.000 for early pericardial effusion and odds ratio 0.04 [0.02–0.08] p < 0.001 for late pericardial effusion; odds ratio 1.64 [1.23–2.20] p = 0.001 for pleural effusion, odds ratio 0.07 [0.02–0.27] p < 0.001 for tamponade, and standard mean difference = 0.01 [−0.12 to 0.14] p = 0.8 for hospital stay. Posterior pericardiotomy is a simple intraoperative technique that can improve postoperative clinical outcomes. However, the incidence of pleural effusion associated with posterior pericardiotomy might be higher.