Metoprolol is frequently administered to cardiac surgery patients to reduce the incidence of postoperative atrial fibrillation (PoAF). Metoprolol is metabolized by the enzyme CYP2D6, which is known to have many mutations that could influence a patient's ability to metabolize the drug. In this prospective clinical trial, the investigators will determine the genotype of CYP2D6 for patients undergoing cardiac surgery, provide an altered dosing recommendation for metoprolol, then report the relative effectiveness in managing PoAF for each pharmacogenetic- guided dosing category. The investigators will also explore the effects of personalized metoprolol dosing recommendations on outcomes in hospital length of stay, cost, and provider participation.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
107
CYP2D6 Genotyping: Consented patients will have blood drawn for genotyping prior to surgery. Patients will be classified as poor metabolizers, intermediate metabolizers, extensive (normal) metabolizers, or ultrafast metabolizers. Pharmacogenetic- Guided Metoprolol Management: A best practice advisory will be integrated into institutional clinical decision support systems for metoprolol dosing based on metabolic status of each patient.
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Incidence of post-operative atrial fibrillation
Incidence of post-operative atrial fibrillation measured with post-operative electrocardiogram or rhythm strip, or at least two of the following: documentation in the progress notes, nursing notes, discharge summary, and change in medication.
Time frame: From the end of anesthesia up to hospital discharge; usually 3-4 days
Rate of genome tailored prescription changes
Rate of genome tailored prescription changes as measured by the proportion of patients in whom metoprolol prescription is based on CYP2D6 metabolizer status.
Time frame: From the end of anesthesia up to hospital discharge; usually 3-4 days
Length of hospital stay
Length of hospital stay (in days) after surgery
Time frame: From end of surgery to hospital discharge; usually 3-4 days
Overall cost of treatment
Time frame: From end of surgery to hospital discharge; usually 3-4 days
Cost of interventions to control or treat post-operative atrial fibrillation
Time frame: From end of anesthesia to hospital discharge; usually 3-4 days
Incidence of adverse drug events
Time frame: From end of anesthesia to hospital discharge; usually 3-4 days
Proportion of clinical decision support tool recommendations that were acknowledged and accepted by provider
Time frame: From end of anesthesia to hospital discharge; usually 3-4 days
Proportion of clinical decision support tool recommendations that were acknowledged but ignored by the provider.
Time frame: From end of anesthesia to hospital discharge; usually 3-4 days
Reasons for non-adherence to recommendations
Reasons for non-adherence to recommendations; prepopulated choices including 1. clinically inappropriate recommendation 2. provider preference 3. Other (free text option).
Time frame: From end of anesthesia to hospital discharge; usually 3-4 days
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