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itemprop="name">Statins for preventing atrial fibrillation after cardiothoracic surgery</span></h1><div class="subtitle">Atrial fibrillation: diagnosis and management</div><p><b>Evidence review M</b></p><p><i>NICE Guideline, No. 196</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2021 Apr</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-4043-1</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div></div><div class="bkr_clear"></div></div><div id="niceng196er14.s1"><h2 id="_niceng196er14_s1_">1. Statins for preventing atrial fibrillation after cardiothoracic surgery</h2><div id="niceng196er14.s1.1"><h3>1.1. Review question: What is the clinical and cost effectiveness of statins in the prevention of atrial fibrillation following cardiothoracic surgery?</h3></div><div id="niceng196er14.s1.2"><h3>1.2. Introduction</h3><p>The post-operative complications associated with cardiac surgery are both long and short term. One of the commonest complications associated with the perioperative period are atrial arrhythmias, including atrial fibrillation (AF), with an incidence reported to be between 10 and 60%. Surgery on the valves carries a higher risk than that of coronary artery bypass surgery (CABG). The occurrence of atrial fibrillation perioperatively not only increases hospital length of stay, but also increases the cost, with the potential for thromboembolic strokes.</p><p>The pathophysiology of atrial arrhythmias is not fully understood, but it is likely to be related to underlying structural factors e.g. volume of the left atrium, together with the traumatic insult of surgery. The highest incidence of atrial fibrillation is within 2 days of surgery with a rapid decline prior to discharge, suggesting reversible factors directly associated with surgery, such as inflammation, are playing a significant role in its development. The introduction of statin therapy at the time of cardiac surgery, has been demonstrated in statin naïve individuals to modulate the inflammatory cytokine response in the heart, via the pleiotropic effects of the statin, and reduce the frequency of AF as well as other morbidities. However, other randomised controlled studies have demonstrated that AF is not prevented, and that certain post-operative complications such as acute kidney injury, are increased in frequency.</p><p>This clinical update is seeking to examine the breath of evidence, clarify the clinical position and ascertain the cost effectiveness of acute statin therapy for the prevention of atrial fibrillation in the perioperative period of cardiac surgery.</p></div><div id="niceng196er14.s1.3"><h3>1.3. PICO table</h3><p>For full details see the review protocol in <a href="#niceng196er14.appa">appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er14tab1"><a href="/books/NBK571336/table/niceng196er14.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er14tab1" rid-ob="figobniceng196er14tab1"><img class="small-thumb" src="/books/NBK571336/table/niceng196er14.tab1/?report=thumb" src-large="/books/NBK571336/table/niceng196er14.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="niceng196er14.tab1"><a href="/books/NBK571336/table/niceng196er14.tab1/?report=objectonly" target="object" rid-ob="figobniceng196er14tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="niceng196er14.s1.4"><h3>1.4. Methods and process</h3><p>This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual.<a class="bibr" href="#niceng196er14.ref65" rid="niceng196er14.ref65"><sup>65</sup></a>Methods specific to this review question are described in the review protocol in <a href="#niceng196er14.appa">appendix A</a>.</p><p>Declarations of interest were recorded according to NICE’s 2014 conflicts of interest policy.</p></div><div id="niceng196er14.s1.5"><h3>1.5. Clinical evidence</h3><div id="niceng196er14.s1.5.1"><h4>1.5.1. Included studies</h4><p>Twenty two randomised trials were identified.<a class="bibr" href="#niceng196er14.ref1" rid="niceng196er14.ref1"><sup>1</sup></a><sup>–</sup><a class="bibr" href="#niceng196er14.ref3" rid="niceng196er14.ref3"><sup>3</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref6" rid="niceng196er14.ref6"><sup>6</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref7" rid="niceng196er14.ref7"><sup>7</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref10" rid="niceng196er14.ref10"><sup>10</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref14" rid="niceng196er14.ref14"><sup>14</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref16" rid="niceng196er14.ref16"><sup>16</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref17" rid="niceng196er14.ref17"><sup>17</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref20" rid="niceng196er14.ref20"><sup>20</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref29" rid="niceng196er14.ref29"><sup>29</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref43" rid="niceng196er14.ref43"><sup>43</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref62" rid="niceng196er14.ref62"><sup>62</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref68" rid="niceng196er14.ref68"><sup>68</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref70" rid="niceng196er14.ref70"><sup>70</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref81" rid="niceng196er14.ref81"><sup>81</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref82" rid="niceng196er14.ref82"><sup>82</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref84" rid="niceng196er14.ref84"><sup>84</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref88" rid="niceng196er14.ref88"><sup>88</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref89" rid="niceng196er14.ref89"><sup>89</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref100" rid="niceng196er14.ref100"><sup>100</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref101" rid="niceng196er14.ref101"><sup>101</sup></a></p><p>Most studies involved coronary artery bypass graft surgery (CABG) but some involved valvular surgery<a class="bibr" href="#niceng196er14.ref1" rid="niceng196er14.ref1"><sup>1</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref2" rid="niceng196er14.ref2"><sup>2</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref10" rid="niceng196er14.ref10"><sup>10</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref16" rid="niceng196er14.ref16"><sup>16</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref29" rid="niceng196er14.ref29"><sup>29</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref68" rid="niceng196er14.ref68"><sup>68</sup></a>or pulmonary resection surgery.<a class="bibr" href="#niceng196er14.ref3" rid="niceng196er14.ref3"><sup>3</sup></a></p><p>Eleven studies involved patients who reported no previous AF or who were in sinus rhythm at baseline, but pre-surgical AF status was unclear in sixstudies,<a class="bibr" href="#niceng196er14.ref14" rid="niceng196er14.ref14"><sup>14</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref17" rid="niceng196er14.ref17"><sup>17</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref20" rid="niceng196er14.ref20"><sup>20</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref62" rid="niceng196er14.ref62"><sup>62</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref82" rid="niceng196er14.ref82"><sup>82</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref88" rid="niceng196er14.ref88"><sup>88</sup></a>and 4studies stated that some patients had experienced previous or current AF.<a class="bibr" href="#niceng196er14.ref2" rid="niceng196er14.ref2"><sup>2</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref10" rid="niceng196er14.ref10"><sup>10</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref89" rid="niceng196er14.ref89"><sup>89</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref101" rid="niceng196er14.ref101"><sup>101</sup></a>Studies not reporting AF incidence as an outcome were excluded to avoid including studies unrelated to atrial fibrillation.</p><p>Four different types of statin were used (simvastatin, atorvastatin, rosuvastatin and pravastatin), and in most studies these were given at higher intensity doses (at a level required to cause >40% reduction in LDL cholesterol). However in 4studies lower intensity doses were given.<a class="bibr" href="#niceng196er14.ref2" rid="niceng196er14.ref2"><sup>2</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref14" rid="niceng196er14.ref14"><sup>14</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref17" rid="niceng196er14.ref17"><sup>17</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref88" rid="niceng196er14.ref88"><sup>88</sup></a></p><p>In 13 studies participants were reported to have <b>not</b> used statins in at least the past 3 months, but pre-study statins use was not reported in 4studies.<a class="bibr" href="#niceng196er14.ref2" rid="niceng196er14.ref2"><sup>2</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref14" rid="niceng196er14.ref14"><sup>14</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref20" rid="niceng196er14.ref20"><sup>20</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref88" rid="niceng196er14.ref88"><sup>88</sup></a> In three studies, pre-study statins were in use by all<a class="bibr" href="#niceng196er14.ref17" rid="niceng196er14.ref17"><sup>17</sup></a>, two thirds<a class="bibr" href="#niceng196er14.ref10" rid="niceng196er14.ref10"><sup>10</sup></a>or a third<a class="bibr" href="#niceng196er14.ref100" rid="niceng196er14.ref100"><sup>100</sup></a>of participants. In these three studies, the patients on pre-study statins had their pre-study statins regimen stopped and replaced by the study statin or placebo in the perioperative period. Pre-study statins were atorvastatin, simvastatin and fluvastatin in the study by Castano<a class="bibr" href="#niceng196er14.ref17" rid="niceng196er14.ref17"><sup>17</sup></a>, but were not specified in the other two studies. In all three studies, pre-study statins were resumed as soon as the study statin/placebo regimen was over.</p><p>The comparator was reported to be placebo in 16studies.<a class="bibr" href="#niceng196er14.ref1" rid="niceng196er14.ref1"><sup>1</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref3" rid="niceng196er14.ref3"><sup>3</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref7" rid="niceng196er14.ref7"><sup>7</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref10" rid="niceng196er14.ref10"><sup>10</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref16" rid="niceng196er14.ref16"><sup>16</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref17" rid="niceng196er14.ref17"><sup>17</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref20" rid="niceng196er14.ref20"><sup>20</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref29" rid="niceng196er14.ref29"><sup>29</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref43" rid="niceng196er14.ref43"><sup>43</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref62" rid="niceng196er14.ref62"><sup>62</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref68" rid="niceng196er14.ref68"><sup>68</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref70" rid="niceng196er14.ref70"><sup>70</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref82" rid="niceng196er14.ref82"><sup>82</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref84" rid="niceng196er14.ref84"><sup>84</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref89" rid="niceng196er14.ref89"><sup>89</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref100" rid="niceng196er14.ref100"><sup>100</sup></a>In one study it was unclear if placebo or usual care was given<a class="bibr" href="#niceng196er14.ref88" rid="niceng196er14.ref88"><sup>88</sup></a>and in four studies the comparator was usual care.<a class="bibr" href="#niceng196er14.ref2" rid="niceng196er14.ref2"><sup>2</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref6" rid="niceng196er14.ref6"><sup>6</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref14" rid="niceng196er14.ref14"><sup>14</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng196er14.ref81" rid="niceng196er14.ref81"><sup>81</sup></a>None of these five studies stated that participants were on pre-study statins, and so participants in the usual care groups were likely to have had the same background treatments as the intervention group, but without statins. Analysis of placebo and usual care studies were combined, on the basis that stratification of the analysis on this basis had not been pre-specified in the protocol.</p><p><a class="figpopup" href="/books/NBK571336/table/niceng196er14.tab2/?report=objectonly" target="object" rid-figpopup="figniceng196er14tab2" rid-ob="figobniceng196er14tab2">Table 2</a> summarises the baseline characteristics of the included studies. The aim of all studies was to assess whether statins are effective at preventing atrial fibrillation in people undergoing cardiothoracic surgery.</p><p><a class="figpopup" href="/books/NBK571336/table/niceng196er14.tab3/?report=objectonly" target="object" rid-figpopup="figniceng196er14tab3" rid-ob="figobniceng196er14tab3">Table 3</a> summarises the findings from the review. For the outcome of atrial fibrillation, significant heterogeneity was noted, and so three pre-planned sub-grouping strategies were applied as outlined in the protocol (<a href="#niceng196er14.appa">Appendix A</a>, <a class="figpopup" href="/books/NBK571336/table/niceng196er14.tab7/?report=objectonly" target="object" rid-figpopup="figniceng196er14tab7" rid-ob="figobniceng196er14tab7">table 7</a>). None of these strategies succeeded in resolving heterogeneity and so results for the sub-groups were not presented, and a random effects model was used for the overall meta-analysis. No serious heterogeneity was observed for the other outcomes.</p><p>There were clinically important benefits observed for statins in reducing atrial fibrillation, but statins also tended to increase mortality. Other outcomes did not show any clinically important effects for statins.</p><p>See also the study selection flow chart in <a href="#niceng196er14.appc">appendix C</a>, study evidence tables in <a href="#niceng196er14.appd">appendix D</a>, forest plots in <a href="#niceng196er14.appe">appendix E</a> and GRADE tables in <a href="#niceng196er14.apph">appendix H</a>.</p></div><div id="niceng196er14.s1.5.2"><h4>1.5.2. Excluded studies</h4><p>See the excluded studies list in <a href="#niceng196er14.appi">appendix I</a>.</p></div><div id="niceng196er14.s1.5.3"><h4>1.5.3. Summary of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er14tab2"><a href="/books/NBK571336/table/niceng196er14.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er14tab2" rid-ob="figobniceng196er14tab2"><img class="small-thumb" src="/books/NBK571336/table/niceng196er14.tab2/?report=thumb" src-large="/books/NBK571336/table/niceng196er14.tab2/?report=previmg" alt="Table 2. Summary of clinical studies included in the evidence review." /></a><div class="icnblk_cntnt"><h4 id="niceng196er14.tab2"><a href="/books/NBK571336/table/niceng196er14.tab2/?report=objectonly" target="object" rid-ob="figobniceng196er14tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of clinical studies included in the evidence review. </p></div></div><p>See <a href="#niceng196er14.appd">appendix D</a> for full evidence tables.</p></div><div id="niceng196er14.s1.5.4"><h4>1.5.4. Quality assessment of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er14tab3"><a href="/books/NBK571336/table/niceng196er14.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er14tab3" rid-ob="figobniceng196er14tab3"><img class="small-thumb" src="/books/NBK571336/table/niceng196er14.tab3/?report=thumb" src-large="/books/NBK571336/table/niceng196er14.tab3/?report=previmg" alt="Table 3. Clinical evidence summary: statins versus placebo or usual care." /></a><div class="icnblk_cntnt"><h4 id="niceng196er14.tab3"><a href="/books/NBK571336/table/niceng196er14.tab3/?report=objectonly" target="object" rid-ob="figobniceng196er14tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: statins versus placebo or usual care. </p></div></div><p>See <a href="#niceng196er14.appf">appendix F</a> for full GRADE tables.</p></div></div><div id="niceng196er14.s1.6"><h3>1.6. Economic evidence</h3><div id="niceng196er14.s1.6.1"><h4>1.6.1. Included studies</h4><p>No relevant health economic studies were identified.</p></div><div id="niceng196er14.s1.6.2"><h4>1.6.2. Excluded studies</h4><p>No health economic studies that were relevant to this question were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#niceng196er14.appg">appendix G</a>.</p></div><div id="niceng196er14.s1.6.3"><h4>1.6.3. Unit costs</h4><p>Relevant unit costs are provided below to aid consideration of costeffectiveness.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er14tab4"><a href="/books/NBK571336/table/niceng196er14.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er14tab4" rid-ob="figobniceng196er14tab4"><img class="small-thumb" src="/books/NBK571336/table/niceng196er14.tab4/?report=thumb" src-large="/books/NBK571336/table/niceng196er14.tab4/?report=previmg" alt="Table 4. UK costs of statins." /></a><div class="icnblk_cntnt"><h4 id="niceng196er14.tab4"><a href="/books/NBK571336/table/niceng196er14.tab4/?report=objectonly" target="object" rid-ob="figobniceng196er14tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">UK costs of statins. </p></div></div><p>The RCTs report a decreased overall hospital length of stay and decreased ICU length of stay for those receiving statins. To aid consideration of cost-effectiveness below are the weighted average cost for excess bed days for patients who have had elective and non-elective CABG are provided in <a class="figpopup" href="/books/NBK571336/table/niceng196er14.tab5/?report=objectonly" target="object" rid-figpopup="figniceng196er14tab5" rid-ob="figobniceng196er14tab5">Table 5</a>and <a class="figpopup" href="/books/NBK571336/table/niceng196er14.tab6/?report=objectonly" target="object" rid-figpopup="figniceng196er14tab6" rid-ob="figobniceng196er14tab6">Table 6</a>. In addition the weighted average total cost of critical care for cardiac and thoracic surgery patients are summarised in <a class="figpopup" href="/books/NBK571336/table/niceng196er14.tab7/?report=objectonly" target="object" rid-figpopup="figniceng196er14tab7" rid-ob="figobniceng196er14tab7">Table 7</a>and National reference costs 2017-2018<a class="bibr" href="#niceng196er14.ref30" rid="niceng196er14.ref30"><sup>30</sup></a>
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<a class="figpopup" href="/books/NBK571336/table/niceng196er14.tab8/?report=objectonly" target="object" rid-figpopup="figniceng196er14tab8" rid-ob="figobniceng196er14tab8">Table 8</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er14tab5"><a href="/books/NBK571336/table/niceng196er14.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er14tab5" rid-ob="figobniceng196er14tab5"><img class="small-thumb" src="/books/NBK571336/table/niceng196er14.tab5/?report=thumb" src-large="/books/NBK571336/table/niceng196er14.tab5/?report=previmg" alt="Table 5. Elective inpatient excess bed days cost." /></a><div class="icnblk_cntnt"><h4 id="niceng196er14.tab5"><a href="/books/NBK571336/table/niceng196er14.tab5/?report=objectonly" target="object" rid-ob="figobniceng196er14tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Elective inpatient excess bed days cost. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er14tab6"><a href="/books/NBK571336/table/niceng196er14.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er14tab6" rid-ob="figobniceng196er14tab6"><img class="small-thumb" src="/books/NBK571336/table/niceng196er14.tab6/?report=thumb" src-large="/books/NBK571336/table/niceng196er14.tab6/?report=previmg" alt="Table 6. Non-elective inpatient excess bed days cost." /></a><div class="icnblk_cntnt"><h4 id="niceng196er14.tab6"><a href="/books/NBK571336/table/niceng196er14.tab6/?report=objectonly" target="object" rid-ob="figobniceng196er14tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Non-elective inpatient excess bed days cost. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er14tab7"><a href="/books/NBK571336/table/niceng196er14.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er14tab7" rid-ob="figobniceng196er14tab7"><img class="small-thumb" src="/books/NBK571336/table/niceng196er14.tab7/?report=thumb" src-large="/books/NBK571336/table/niceng196er14.tab7/?report=previmg" alt="Table 7. Critical care cardiac surgical adult patients cost." /></a><div class="icnblk_cntnt"><h4 id="niceng196er14.tab7"><a href="/books/NBK571336/table/niceng196er14.tab7/?report=objectonly" target="object" rid-ob="figobniceng196er14tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Critical care cardiac surgical adult patients cost. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng196er14tab8"><a href="/books/NBK571336/table/niceng196er14.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figniceng196er14tab8" rid-ob="figobniceng196er14tab8"><img class="small-thumb" src="/books/NBK571336/table/niceng196er14.tab8/?report=thumb" src-large="/books/NBK571336/table/niceng196er14.tab8/?report=previmg" alt="Table 8. Critical care thoracic surgical adult patients cost." /></a><div class="icnblk_cntnt"><h4 id="niceng196er14.tab8"><a href="/books/NBK571336/table/niceng196er14.tab8/?report=objectonly" target="object" rid-ob="figobniceng196er14tab8">Table 8</a></h4><p class="float-caption no_bottom_margin">Critical care thoracic surgical adult patients cost. </p></div></div></div></div><div id="niceng196er14.s1.7"><h3>1.7. The committee’s discussion of the evidence</h3><div id="niceng196er14.s1.7.1"><h4>1.7.1. Interpreting the evidence</h4><div id="niceng196er14.s1.7.1.1"><h5>1.7.1.1. The outcomes that matter most</h5><p>The committee agreed that the most important (critical) outcomes were incidence of post-operative atrial fibrillation, mortality, stroke and quality of life. Rehospitalisation was deemed relatively less important, but more important than hospital length of stay and ICU duration. No evidence was found for effects on quality of life.</p></div><div id="niceng196er14.s1.7.1.2"><h5>1.7.1.2. The quality of the evidence</h5><p>The clinical evidence for the critical outcomes of atrial fibrillation, mortality and stroke were graded very low. For atrial fibrillation this was largely due to very serious risk of bias (many studies had unclear reporting of allocation concealment and no assessor blinding) and serious heterogeneity and imprecision. For mortality and stroke this was due to serious risk of bias (mostly due to poor reporting of allocation concealment) and very serious imprecision.</p><p>Hospital readmission was deemed low quality evidence due to very serious imprecision. Hospital length of stay was deemed as low quality evidence due to serious imprecision and serious risk of bias. ICU length of stay was graded as moderate quality as it has serious risk of bias only.</p><p>For the post-operative AF outcome, a further possible quality issue was highlighted by the committee. One possible post-hoc reason for the unresolved heterogeneity in the post-operative AF outcome was suggested as differences between studies in underlying beta-blocker or amiodarone use across both trial arms. For example, in studies where more patients were taking these drugs as a background treatment, these drugs may have reduced any post-operative AF in both arms, thus prohibiting detection of any independent preventative effects from statins.</p><p>The committee also highlighted the fact that some recent evidence from larger studies was of higher quality than the older and smaller studies. The committee felt that a greater weighting should be placed upon the findings of these newer high quality studies that tended to show no benefits and clear harms from statins in the peri-operative period. The committee noted that these studies had been done specifically because of uncertainty after meta-analysis of the earlier studies.</p></div><div id="niceng196er14.s1.7.1.3"><h5>1.7.1.3. Benefits and harms</h5><p>The pooled evidence suggested that statins may have a small clinical benefit in reducing the incidence of atrial fibrillation after cardiothoracic surgery, compared to placebo/usual care. The committee noted that this pooled effect was driven by evidence from the large number of poor quality studies. Meanwhile, the evidence from newer, larger and higher quality trials did not show any such preventative benefit from statins, but the smaller number of such studies prevented them having an impact on the pooled result. Based on these qualitative impressions (further analysis was not carried out) the committee felt that the results from these newer studies should be given more emphasis. On the basis of this, the committee concluded that statins were not an effective approach to prevent AF.</p><p>Furthermore, the committee agreed that although statins did not increase or decrease the short-term risks of stroke, the point estimate in the mortality analysis indicated that statins might lead to greater mortality than placebo/usual care. This effect was imprecise, with the 95% confidence intervals showing the population result was consistent with no effect from statins, or even a protective effect from statins. Nevertheless, it was agreed that there was a relatively high probability that statins would lead to a real degree of increased mortality in the population.</p><p>Hospital readmission was reduced by statins in the single study sample that evaluated this outcome, but the estimate of effects in the population (as shown by the 95% confidence intervals) was seriously imprecise, and was therefore consistent with clinical harm as well as clinical benefit. This was therefore not considered in the weighing up of benefits and harms.</p><p>Although there were estimated to be non-spurious reductions from statins in ICU and hospital length of stay, the reduction was not deemed clinically important . Given this, combined with the relatively lower importance of these two outcomes, and the fact that the two largest studies did not report length of stay, the committee placed less emphasis on this evidence in the weighing up of benefits and harms.</p><p>Overall then, the committee felt there were likely to be few benefits of statins on AF alongside a possible small increased risk of death. The committee were agreed that there should not be a recommendation that statins be used for prevention of AF after cardiothoracic surgery, and discussed whether there should be no recommendation at all, or a stronger approach involving a recommendation not to use statins for prevention of AF after cardiothoracic surgery. The committee agreed on the latter approach after further consideration of the harms and lack of benefits, and when convinced that the recommendation could be effectively worded to avoid misinterpretation by patients that essential statin use for other purposes was harmful.</p></div></div><div id="niceng196er14.s1.7.2"><h4>1.7.2. Cost effectiveness and resource use</h4><p>No relevant health economic analyses were identified for this review; therefore unit costs were presented to aid committee consideration of cost effectiveness. The unit costs of statins were presented; these were considered by the committee to be low at between £0.02 and £0.61per course. A decreased overall length of stay and decreased ICU stay for those receiving statins was reported. CABG is the most common cardiothoracic surgery reported in the studies and so the weighted average costs of excess bed days for patients undergoing elective and non-elective CABG were presented (£348 and £427 respectively). In addition the weighted average total cost of critical care for cardiac and thoracic surgery patients were presented (£1,301 and £1,182 respectively). Although the reduced overall length of stay and ICU stay could result in a saving to the NHS, the committee were wary of placing too much importance on this due to the nature of this outcome which is often very dependent on external factors such as targets and availability of beds. The committee noted that there are huge variations in length of stay nationally, and that these are greater than those seen in the studies reported.</p><p>The clinical evidence suggested that statins were not an effective approach to prevent atrial fibrillation. No evidence was identified relating to quality of life and an increase in mortality in those receiving statins was reported. Overall this would suggest that statins used in this way would result in a loss of QALYs. As a result the committee considered that although this is a low cost intervention that may result in some savings (due to reduced length of stay) these savings were not deemed to be sufficient to offset the harms in terms of increased mortality. As a result they made a recommendation to not routinely recommend statins specifically for the prevention of atrial fibrillation after cardiothoracic surgery. The committee noted that in current practice many patients undergoing cardiothoracic surgery are likely to already be receiving statins and that this recommendation would not apply to them. This recommendation will not result in a change in practice and so will not have a resource impact.</p></div><div id="niceng196er14.s1.7.3"><h4>1.7.3. Other factors the committee took into account</h4><p>It was highlighted that a message not to take statins (albeit in the context of preventing AF post-cardiac surgery) could be misinterpreted by patients, and could lead to a desire to avoid all statins use, including that which was essential. It was observed how most patients having cardiothoracic surgery (such as patients undergoing CABG) benefit greatly from taking statins before and after the peri-operative period for prevention of serious cardiovascular events other than AF. However after further discussion about the need to focus attention on the results from the high quality studies, and an emphasis on the possible harms, it was agreed that is was important that the committee should make it clear, in a very precise and non-ambiguous recommendation, that statins should not be started solely for the purposes of preventing AF in people who had no other indication for statins. In addition it was agreed that there should be a cross-referral to the NICE Statins guidelines to emphasise the need for those people who needed statins for other purposes to continue using them. It was agreed that the proportion of people to whom this recommendation applied would be small (as most people having CABG, the most prevalent cardiothoracic surgery, would still need statins for other purposes). However it was agreed that this small group would, after weighing the balance and harms, benefit from such a recommendation.</p></div></div></div><div id="niceng196er14.rl.r1"><h2 id="_niceng196er14_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="niceng196er14.ref1">Allah
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S, di Niro
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A, Gianfagna
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F, Donati
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MB, de Gaetano
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BA, Buise
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MP, van Zundert
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AA. Perioperative statin therapy in patients at high risk for cardiovascular morbidity undergoing surgery: a review. British Journal of Anaesthesia. 2015; 114(1):44–52 [<a href="https://pubmed.ncbi.nlm.nih.gov/25186819" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25186819</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="niceng196er14.ref29">Dehghani
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MR, Kasianzadeh
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M, Rezaei
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Y, Sepehrvand
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N. Atorvastatin reduces the incidence of postoperative atrial fibrillation in statin-naive patients undergoing isolated heart valve surgery: a double-blind, placebo-controlled randomized trial. Journal of Cardiovascular Pharmacology and Therapeutics. 2015; 20(5):465–472 [<a href="https://pubmed.ncbi.nlm.nih.gov/25540059" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25540059</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="niceng196er14.ref30">Department of Health. NHS reference costs 2017-18. 2018. Available from: <a href="https://improvement.nhs.uk/resources/reference-costs/#rc1718" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://improvement<wbr style="display:inline-block"></wbr>​.nhs<wbr style="display:inline-block"></wbr>​.uk/resources/reference-costs/#rc1718</a> Last accessed: 21/01/20.</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="niceng196er14.ref31">Dong
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L, Zhang
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F, Shu
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X. Usefulness of statins pretreatment for the prevention of postoperative atrial fibrillation in patients undergoing cardiac surgery. Annals of Medicine. 2011; 43(1):69–74 [<a href="https://pubmed.ncbi.nlm.nih.gov/21108566" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21108566</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="niceng196er14.ref32">Drummond
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LW, Torborg
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AM, Rodseth
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RN, Biccard
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BM. Postoperative atrial fibrillation in patients on statins undergoing isolated cardiac valve surgery: a meta-analysis. Southern African Journal of Anaesthesia and Analgesia. 2014; 20(6):238–244</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="niceng196er14.ref33">Dunkelgrun
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M, Boersma
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E, Schouten
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O, Koopman-van Gemert
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AW, van Poorten
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F, Bax
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IY, Mahmoud
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A, Huo
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T, Beaver
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TM, Bavry
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AA. Meta-analysis of 12 trials evaluating the effects of statins on decreasing atrial fibrillation after coronary artery bypass grafting. American Journal of Cardiology. 2015; 115(11):1523–1528 [<a href="https://pubmed.ncbi.nlm.nih.gov/25843920" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25843920</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="niceng196er14.ref35">Fauchier
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L, Pierre
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B, de Labriolle
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A, Grimard
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C, Zannad
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N, Babuty
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D. Antiarrhythmic effect of statin therapy and atrial fibrillation a meta-analysis of randomized controlled trials. Journal of the American College of Cardiology. 2008; 51(8):828–835 [<a href="https://pubmed.ncbi.nlm.nih.gov/18294568" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18294568</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="niceng196er14.ref36">Florens
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E, Salvi
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S, Peynet
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J, Elbim
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C, Mallat
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Z, Bel
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RC, Almeida-Gutierrez
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E, Serrano-Cuevas
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L, Sanchez-Diaz
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JS, Rosas-Peralta
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M, Ortega-Ramirez
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JA
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SL, Yap
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KH, Chua
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KC, Chao
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VT. Does preoperative statin therapy prevent postoperative atrial fibrillation in patients undergoing cardiac surgery?
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JN, Jiang
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L, Zhang
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RY. Evaluation of rosuvastatin in preventing early recurrence of persistent atrial fibrillation after catheter ablation treatment. Journal of Interventional Radiology - China. 2014; 23(10):848–852</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="niceng196er14.ref40">Hadi
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NR, Ghazi
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A, Amber
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KI, Majeed
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PA, Barnes
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AE, Majeed
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SA, Hadi
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NR, Amber
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KI, Jawad
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H. Atorvastatin reload down regulates TLR-2 expression and reduces the acute inflammatory response in patients undergoing percutaneous coronary intervention. Systematic Reviews in Pharmacy. 2020; 11(2):347–355</div></dd></dl><dl class="bkr_refwrap"><dt>43.</dt><dd><div class="bk_ref" id="niceng196er14.ref43">Ji
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Q, Mei
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X, Sun
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JA, Laurikka
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JO, Jarvinen
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OH, Khan
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NK, Jarvela
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KM. Early postoperative statin administration does not affect the rate of atrial fibrillation after cardiac surgery. European Journal of Cardio-Thoracic Surgery. 2020; 57(6):1154–1159 [<a href="https://pubmed.ncbi.nlm.nih.gov/31930308" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31930308</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>45.</dt><dd><div class="bk_ref" id="niceng196er14.ref45">Kinoshita
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T, Asai
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T, Nishimura
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O, Hiramatsu
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N, Suzuki
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T, Kambara
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A, Valencia
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O, Hosseini
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MT, Mayr
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M, Sarsam
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EW, Liakopoulos
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OJ, Choi
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YH, Rahmanian
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P, Eghbalzadeh
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K, Slottosch
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EW, Liakopoulos
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OJ, Stange
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S, Deppe
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AC, Slottosch
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EW, Liakopoulos
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OJ, Stange
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S, Deppe
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EW, Slottosch
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T, Liakopoulos
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A, Abreu
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AM, Boronat
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V, Ruel
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A, Ruel
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M. Statins and coronary artery bypass graft surgery: preoperative and postoperative efficacy and safety. Expert Opinion on Drug Safety. 2009; 8(5):559–571 [<a href="https://pubmed.ncbi.nlm.nih.gov/19673591" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19673591</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>53.</dt><dd><div class="bk_ref" id="niceng196er14.ref53">Kunt
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A, Ozcan
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S, Kucuker
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A, Odabasi
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D, Sami Kunt
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A. Effects of perioperative statin treatment on postoperative atrial fibrillation and cardiac mortality in patients undergoing coronary artery bypass grafting: a propensity score analysis. Medicinski Glasnik Ljekarske Komore Zenickodobojskog Kantona. 2015; 12(2):190–195 [<a href="https://pubmed.ncbi.nlm.nih.gov/26276658" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26276658</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>54.</dt><dd><div class="bk_ref" id="niceng196er14.ref54">Kyle
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AA, Arif
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MY, Eugene
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C, Jeff
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SH, Carlos
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AM, Girish
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K, White
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CM, Kluger
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CI. Preoperative statins for the prevention of atrial fibrillation after cardiothoracic surgery. Journal of Thoracic and Cardiovascular Surgery. 2008; 135(2):405–411 [<a href="https://pubmed.ncbi.nlm.nih.gov/18242276" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18242276</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>56.</dt><dd><div class="bk_ref" id="niceng196er14.ref56">Liakopoulos
|
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OJ, Choi
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PL, Strauch
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OJ, Choi
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YH, Kuhn
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EW, Wittwer
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T, Borys
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OJ, Kuhn
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EW, Hellmich
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M, Kuhr
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K, Krause
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T, Korantzopoulos
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B, Sun
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H, Furuse
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A, Endo
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M, Nakamura
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VA, Iorio
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D, De Amicis
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V, Di Lello
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DR, Myles
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A, Fino
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C, Fiorani
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B, Yeatman
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M, Narayan
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P, Angelini
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GD. Effects of preoperative statin treatment on the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. Annals of Thoracic Surgery. 2009; 87(6):1853–1858 [<a href="https://pubmed.ncbi.nlm.nih.gov/19463608" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19463608</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>65.</dt><dd><div class="bk_ref" id="niceng196er14.ref65">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [Updated October 2018]. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org<wbr style="display:inline-block"></wbr>​.uk/process/pmg20/chapter<wbr style="display:inline-block"></wbr>​/introduction-and-overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>66.</dt><dd><div class="bk_ref" id="niceng196er14.ref66">Oesterle
|
|
A, Weber
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B, Tung
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R, Choudhry
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NK, Singh
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JP, Upadhyay
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GA. Preventing postoperative atrial fibrillation after noncardiac surgery: a meta-analysis. American Journal of Medicine. 2018; 131(7):795–804.e795 [<a href="https://pubmed.ncbi.nlm.nih.gov/29476748" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29476748</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>67.</dt><dd><div class="bk_ref" id="niceng196er14.ref67">Ozaydin
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M. Atorvastatin for reduction of myocardial dysrhythmia after cardiac surgery study. Future Cardiology. 2007; 3(2):127–129 [<a href="https://pubmed.ncbi.nlm.nih.gov/19804239" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19804239</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>68.</dt><dd><div class="bk_ref" id="niceng196er14.ref68">Park
|
|
JH, Shim
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JK, Song
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JW, Soh
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S, Kwak
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YL. Effect of atorvastatin on the incidence of acute kidney injury following valvular heart surgery: a randomized, placebo-controlled trial. Intensive Care Medicine. 2016; 42(9):1398–1407 [<a href="https://pubmed.ncbi.nlm.nih.gov/27120082" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27120082</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>69.</dt><dd><div class="bk_ref" id="niceng196er14.ref69">Patti
|
|
G, Bennett
|
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R, Seshasai
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SR, Cannon
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CP, Cavallari
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I, Chello
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M
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|
|
G, Chello
|
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M, Candura
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D, Pasceri
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V, D’Ambrosio
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A, Covino
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E
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|
MD, Crescenzi
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|
G, Zingaro
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C, D’Alfonso
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A, Capestro
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F, Scocco
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V
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|
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H, Lashkari
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R, Aminorroaya
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A, Soltani
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D, Jalali
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A, Tajdini
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M. Effects of high dose atorvastatin before elective percutaneous coronary intervention on highly sensitive troponin T and one year major cardiovascular events; a randomized clinical trial. IJC Heart and Vasculature. 2019; 22:96–101 [<a href="/pmc/articles/PMC6328087/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6328087</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30671535" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30671535</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>73.</dt><dd><div class="bk_ref" id="niceng196er14.ref73">Prowle
|
|
JR, Calzavacca
|
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P, Licari
|
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E, Ligabo
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EV, Echeverri
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JE, Haase
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M
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|
|
A, Capelli
|
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B, Belletti
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A, Cassina
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T, Ferrari
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E, Gallo
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M
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et al. Perioperative statin therapy in cardiac surgery: a meta-analysis of randomized controlled trials. Critical Care. 2016; 20(1):395 [<a href="/pmc/articles/PMC5139027/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5139027</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27919293" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27919293</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>75.</dt><dd><div class="bk_ref" id="niceng196er14.ref75">Rubanenko
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OA. Efficacy of atorvastatin therapy in prevention of postoperative atrial fibrillation in patients with ischemic heart disease. Rational Pharmacotherapy in Cardiology. 2015; 11(5):464–469</div></dd></dl><dl class="bkr_refwrap"><dt>76.</dt><dd><div class="bk_ref" id="niceng196er14.ref76">Sai
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C, Li
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J, Ruiyan
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M, Yingbin
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X. Atorvastatin prevents postoperative atrial fibrillation in patients undergoing cardiac surgery. Hellenic Journal of Cardiology. 2018; 04:1–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/29307691" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29307691</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>77.</dt><dd><div class="bk_ref" id="niceng196er14.ref77">Sanders
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RD, Nicholson
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A, Lewis
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SR, Smith
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AF, Alderson
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P. Perioperative statin therapy for improving outcomes during and after noncardiac vascular surgery. Cochrane Database of Systematic Reviews
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2013, Issue 7. Art. No.: CD009971. DOI: 10.1002/14651858.CD009971.pub2. [<a href="/pmc/articles/PMC8928737/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8928737</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23824754" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23824754</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD009971.pub2" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>78.</dt><dd><div class="bk_ref" id="niceng196er14.ref78">Sasmazel
|
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A, Baysal
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A, Fedekar
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A, Buyukbayrak
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F, Bugra
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O, Erdem
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|
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A, Forouzannia
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SK, Davarpasand
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T, Talasaz
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AH, Jalali
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A, Gorabi
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AM
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et al. Comparison of the effect of 80 vs 40 mg atorvastatin in patients with isolated coronary artery bypass graft surgery: A randomized clinical trial. Journal of Cardiac Surgery. 2019; 34(8):670–675 [<a href="https://pubmed.ncbi.nlm.nih.gov/31212365" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31212365</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>80.</dt><dd><div class="bk_ref" id="niceng196er14.ref80">Slhessarenko
|
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JR, Hirata
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M, Sousa
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A, Bastos
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GM, Higa
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EMS, Mouro
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MG
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|
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YB, On
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YK, Kim
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JH, Shin
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DH, Kim
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JS, Sung
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et al. The effects of atorvastatin on the occurrence of postoperative atrial fibrillation after off-pump coronary artery bypass grafting surgery. American Heart Journal. 2008; 156(2):373.e379–316 [<a href="https://pubmed.ncbi.nlm.nih.gov/18657672" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18657672</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>82.</dt><dd><div class="bk_ref" id="niceng196er14.ref82">Spadaccio
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C, Pollari
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F, Cascalenda
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A, Alfano
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G, Genovese
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J, Covino
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et al. Atorvastatin increases the number of endothelial progenitor cells after cardiac surgery: a randomised control study. Journal of Cardiovascular Pharmacology. 2010; 55(1):30–38 [<a href="https://pubmed.ncbi.nlm.nih.gov/19834333" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19834333</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>83.</dt><dd><div class="bk_ref" id="niceng196er14.ref83">Suleiman
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M, Koestler
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C, Lerman
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A, Lopez-Jimenez
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F, Herges
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R, Hodge
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D
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et al. Atorvastatin for prevention of atrial fibrillation recurrence following pulmonary vein isolation: a double-blind, placebo-controlled, randomized trial. Heart Rhythm. 2012; 9(2):172–178 [<a href="https://pubmed.ncbi.nlm.nih.gov/21920481" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21920481</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>84.</dt><dd><div class="bk_ref" id="niceng196er14.ref84">Sun
|
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Y, Ji
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Q, Mei
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Y, Wang
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X, Feng
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J, Cai
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et al. Role of preoperative atorvastatin administration in protection against postoperative atrial fibrillation following conventional coronary artery bypass grafting. International Heart Journal. 2011; 52(1):7–11 [<a href="https://pubmed.ncbi.nlm.nih.gov/21321461" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21321461</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>85.</dt><dd><div class="bk_ref" id="niceng196er14.ref85">Sun
|
|
YF, Mei
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YQ, Ji
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Q, Wang
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XS, Feng
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J, Cai
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JZ
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et al. Effect of atorvastatin on postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. Chinese Medical Journal. 2009; 89(42):2988–2991 [<a href="https://pubmed.ncbi.nlm.nih.gov/20137710" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20137710</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>86.</dt><dd><div class="bk_ref" id="niceng196er14.ref86">Takagi
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H, Umemoto
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T. Effect of preoperative statin therapy on postoperative atrial fibrillation in cardiac surgery. Circulation Journal. 2010; 74(12):2788–2789 [<a href="https://pubmed.ncbi.nlm.nih.gov/20921813" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20921813</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>87.</dt><dd><div class="bk_ref" id="niceng196er14.ref87">Tamayo
|
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E, Alonso
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O, Alvarez
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FJ, Castrodeza
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J, Flórez
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S, di Stefano
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S. Effects of simvastatin on acute-phase protein levels after cardiac surgery. Medicina Clínica. 2008; 130(20):773–775 [<a href="https://pubmed.ncbi.nlm.nih.gov/18579030" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18579030</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>88.</dt><dd><div class="bk_ref" id="niceng196er14.ref88">Tamayo
|
|
E, Alvarez
|
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FJ, Alonso
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O, Bustamante
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R, Castrodeza
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J, Soria
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S
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et al. Effects of simvastatin on systemic inflammatory responses after cardiopulmonary bypass. Journal of Cardiovascular Surgery. 2009; 50(5):687–694 [<a href="https://pubmed.ncbi.nlm.nih.gov/19741581" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19741581</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>89.</dt><dd><div class="bk_ref" id="niceng196er14.ref89">Vukovic
|
|
PM, Maravic-Stojkovic
|
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VR, Peric
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MS, Jovic
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M, Cirkovic
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MV, Gradinac
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Y, Zhu
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S, Du
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R, Zhou
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J, Chen
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Y, Zhang
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Q. Statin initiation and renal outcomes following isolated coronary artery bypass grafting: a meta-analysis. Journal of Cardiovascular Surgery. 2018; 59(2):282–290 [<a href="https://pubmed.ncbi.nlm.nih.gov/29145723" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29145723</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>91.</dt><dd><div class="bk_ref" id="niceng196er14.ref91">Winchester
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DE, Wen
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X, Xie
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L, Bavry
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AA. Evidence of pre-procedural statin therapy a meta-analysis of randomized trials. Journal of the American College of Cardiology. 2010; 56(14):1099–1109 [<a href="https://pubmed.ncbi.nlm.nih.gov/20825761" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20825761</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>92.</dt><dd><div class="bk_ref" id="niceng196er14.ref92">Xia
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J, Qu
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Y, Shen
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H, Liu
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X. Patients with stable coronary artery disease receiving chronic statin treatment who are undergoing noncardiac emergency surgery benefit from acute atorvastatin reload. Cardiology. 2014; 128(3):285–292 [<a href="https://pubmed.ncbi.nlm.nih.gov/24903511" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24903511</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>93.</dt><dd><div class="bk_ref" id="niceng196er14.ref93">Yin
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L, Wang
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Z, Wang
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Y, Ji
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G, Xu
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Z. Effect of statins in preventing postoperative atrial fibrillation following cardiac surgery. Journal of Atrial Fibrillation. 2010; 2(5):214 [<a href="/pmc/articles/PMC4956008/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4956008</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28496649" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28496649</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>94.</dt><dd><div class="bk_ref" id="niceng196er14.ref94">Youn
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YN, Park
|
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SY, Hwang
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Y, Joo
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HC, Yoo
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KJ. Impact of high-dose statin pretreatment in patients with stable angina during off-pump coronary artery bypass. The Korean Journal of Thoracic and Cardiovascular Surgery. 2011; 44(3):208–214 [<a href="/pmc/articles/PMC3249304/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3249304</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22263153" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22263153</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>95.</dt><dd><div class="bk_ref" id="niceng196er14.ref95">Yuan
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|
X, Du
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J, Liu
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Q, Zhang
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L. Defining the role of perioperative statin treatment in patients after cardiac surgery: A meta-analysis and systematic review of 20 randomized controlled trials. International Journal of Cardiology. 2017; 228:958–966 [<a href="https://pubmed.ncbi.nlm.nih.gov/27914358" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27914358</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>96.</dt><dd><div class="bk_ref" id="niceng196er14.ref96">Zhang
|
|
J, Feng
|
|
R, Ferdous
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|
M, Dong
|
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B, Yuan
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H, Zhao
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P. Effect of 2 different dosages of rosuvastatin on prognosis of acute myocardial infarction patients with new-onset atrial fibrillation in Jinan, China. Medical Science Monitor. 2020; 26:e925666 [<a href="/pmc/articles/PMC7444617/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7444617</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32785210" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32785210</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>97.</dt><dd><div class="bk_ref" id="niceng196er14.ref97">Zhao
|
|
G, Wu
|
|
L, Liu
|
|
Y, Gao
|
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L, Chen
|
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Y, Yao
|
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R
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et al. Rosuvastatin reduces the recurrence rate following catheter ablation for atrial fibrillation in patients with heart failure. Biomedical Reports. 2017; 6(3):346–352 [<a href="/pmc/articles/PMC5403218/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5403218</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28451398" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28451398</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>98.</dt><dd><div class="bk_ref" id="niceng196er14.ref98">Zhen-Han
|
|
L, Rui
|
|
S, Dan
|
|
C, Xiao-Li
|
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Z, Qing-Chen
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W, Bo
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F. Perioperative statin administration with decreased risk of postoperative atrial fibrillation, but not acute kidney injury or myocardial infarction: a meta-analysis. Scientific Reports. 2017; 7(1):10091 [<a href="/pmc/articles/PMC5577099/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5577099</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28855628" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28855628</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>99.</dt><dd><div class="bk_ref" id="niceng196er14.ref99">Zheng
|
|
H, Xue
|
|
S, Hu
|
|
ZL, Shan
|
|
JG, Yang
|
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WG. The use of statins to prevent postoperative atrial fibrillation after coronary artery bypass grafting: a meta-analysis of 12 studies. Journal of Cardiovascular Pharmacology. 2014; 64(3):285–292 [<a href="https://pubmed.ncbi.nlm.nih.gov/24705176" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24705176</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>100.</dt><dd><div class="bk_ref" id="niceng196er14.ref100">Zheng
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Z, Jayaram
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R, Jiang
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L, Emberson
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J, Zhao
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Y, Li
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Q
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et al. Perioperative rosuvastatin in cardiac surgery. New England Journal of Medicine. 2016; 374(18):1744–1753 [<a href="https://pubmed.ncbi.nlm.nih.gov/27144849" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27144849</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>101.</dt><dd><div class="bk_ref" id="niceng196er14.ref101">Zhou
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L, Liu
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X, Wang
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ZQ, Li
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Y, Shi
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MM, Xu
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Z
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et al. Simvastatin treatment protects myocardium in noncoronary artery cardiac surgery by inhibiting apoptosis through miR-15a-5p targeting. Journal of Cardiovascular Pharmacology. 2018; 72(4):176–185 [<a href="https://pubmed.ncbi.nlm.nih.gov/29985281" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29985281</span></a>]</div></dd></dl></dl></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng196er14.appa"><h3>Appendix A. Review protocols</h3><p id="niceng196er14.appa.et1"><a href="/books/NBK571336/bin/niceng196er14-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (228K)</span></p></div><div id="niceng196er14.appb"><h3>Appendix B. Literature search strategies</h3><p>This literature search strategy was used for the following reviews:
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<ul><li class="half_rhythm"><div><b>What is the clinical and cost effectiveness of statins in the prevention of atrial fibrillation following cardiothoracic surgery?</b></div></li></ul></p><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual.<a class="bibr" href="#niceng196er14.ref65" rid="niceng196er14.ref65"><sup>65</sup></a></p><p>For more information, please see the Methods Report published as part of the accompanying documents for this guideline.</p><p id="niceng196er14.appb.et1"><a href="/books/NBK571336/bin/niceng196er14-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.1. Clinical search literature search strategy</a><span class="small"> (PDF, 284K)</span></p><p id="niceng196er14.appb.et2"><a href="/books/NBK571336/bin/niceng196er14-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.2. Health Economics literature search strategy</a><span class="small"> (PDF, 230K)</span></p></div><div id="niceng196er14.appc"><h3>Appendix C. Clinical evidence selection</h3><p id="niceng196er14.appc.et1"><a href="/books/NBK571336/bin/niceng196er14-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (32K)</span></p></div><div id="niceng196er14.appd"><h3>Appendix D. Clinical evidence tables</h3><p id="niceng196er14.appd.et1"><a href="/books/NBK571336/bin/niceng196er14-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (626K)</span></p></div><div id="niceng196er14.appe"><h3>Appendix E. Forest plots</h3><p id="niceng196er14.appe.et1"><a href="/books/NBK571336/bin/niceng196er14-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (45K)</span></p></div><div id="niceng196er14.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng196er14.appf.et1"><a href="/books/NBK571336/bin/niceng196er14-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (61K)</span></p></div><div id="niceng196er14.appg"><h3>Appendix G. Health economic evidence selection</h3><p id="niceng196er14.appg.et1"><a href="/books/NBK571336/bin/niceng196er14-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (83K)</span></p></div><div id="niceng196er14.apph"><h3>Appendix H. Health economic evidence tables</h3><p>None.</p></div><div id="niceng196er14.appi"><h3>Appendix I. Excluded studies</h3><div id="niceng196er14.appi.s1"><h4>I.1. Excluded clinical studies</h4><p id="niceng196er14.appi.et1"><a href="/books/NBK571336/bin/niceng196er14-appi-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (188K)</span></p></div><div id="niceng196er14.appi.s2"><h4>I.2. Excluded health economic studies</h4><p>None.</p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Intervention evidence review</p><p>Developed by the National Guideline Centre, Royal College of Physicians</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patientand, where appropriate,their carer or guardian.</p><p>Local commissioners andproviders have a responsibility to enable the guideline to be applied when individual health professionals and theirpatients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div><div class="small"><span class="label">Bookshelf ID: NBK571336</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/34165934" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">34165934</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng196er14tab1"><div id="niceng196er14.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571336/table/niceng196er14.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er14.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng196er14.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng196er14.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People aged over 18who have had cardiothoracic surgery. They do NOT need to have had previous or current AF. Studies including >3% of people undergoing congenital heart valve defect surgery were excluded.</td></tr><tr><th id="hd_b_niceng196er14.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention(s)</th><td headers="hd_b_niceng196er14.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Any statin as listed in the BNF (Simvastatin, Atorvastatin, Rosuvastatin, Pravastatin, Fluvastatin), given perioperatively.</td></tr><tr><th id="hd_b_niceng196er14.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison(s)</th><td headers="hd_b_niceng196er14.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Placebo, or usual Care / no treatment</td></tr><tr><th id="hd_b_niceng196er14.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng196er14.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><u>Critical</u>
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<ul><li class="half_rhythm"><div>AF post-surgery</div></li><li class="half_rhythm"><div>health-related quality of life</div></li><li class="half_rhythm"><div>mortality</div></li><li class="half_rhythm"><div>stroke or thromboembolic complications</div></li><li class="half_rhythm"><div>Hospital readmission</div></li></ul></p>
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<p>Important
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<ul><li class="half_rhythm"><div>Hospital length of stay</div></li><li class="half_rhythm"><div>ICU length of stay</div></li></ul></p></td></tr><tr><th id="hd_b_niceng196er14.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng196er14.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng196er14tab2"><div id="niceng196er14.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of clinical studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571336/table/niceng196er14.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er14.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cardiothoracic surgery details</th><th id="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n</th><th id="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High intensity dose?<sup>(a)</sup></th><th id="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator</th><th id="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Previous AF</th><th id="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Previous statins use?</th><th id="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Follow up duration</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Allah 2019<a class="bibr" href="#niceng196er14.ref1" rid="niceng196er14.ref1"><sup>1</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective valve replacement surgery for people with Rheumatic heart disease</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Egypt. Age 29; male 54%; No AF; No hepatic history</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 80mg 12 and 2 hours pre-operatively, and then on the 2<sup>nd</sup>–5<sup>th</sup>post-operative days.</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 days</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Almansob 2012<a class="bibr" href="#niceng196er14.ref2" rid="niceng196er14.ref2"><sup>2</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective non-coronary artery cardiac surgery (>50% valvular surgery)</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">China. Age 43; male 50%; chronic AF 21%; NYHA III or IV: 71%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">151</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Simvastatin 20mg daily, started 5-7 days pre-op and then from 2<sup>nd</sup>day post-op (termination unclear)</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Usual care</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes, in 21%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear, but not in exclusion criteria, so possible</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 days</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Amar 2015<a class="bibr" href="#niceng196er14.ref3" rid="niceng196er14.ref3"><sup>3</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective pulmonary resection</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">USA. Age >18; increased bp 35%; ASA score >2: 46%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">137</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 40mg daily, started 1 week before surgery and 1 week post-op</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No – AF exclusion criterion</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No active statins use</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hospital stay</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Aydin 2015<a class="bibr" href="#niceng196er14.ref6" rid="niceng196er14.ref6"><sup>6</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective CABG</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Turkey. Age 62; 78% male;57% hypertension; LVEF <50%; NYHA>II-IV: 8%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 40mg daily, for 30 days immediately after CABG</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Usual care</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No – AF exclusion criterion</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No – exclusion criterion</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30d</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Baran 2012<a class="bibr" href="#niceng196er14.ref7" rid="niceng196er14.ref7"><sup>7</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective CABG on pump</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Turkey. Age 61; male 62%; hypertension 60%; NYHA class III: 37%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 40mg daily, for 2 weeks before CABG. Then from day 1 post op for unclear duration</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Probably not: presented with sinus rhythm, but no data on previous AF</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No statin treatment in previous 3 months</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30d</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Billings 2016<a class="bibr" href="#niceng196er14.ref10" rid="niceng196er14.ref10"><sup>10</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective CABG, valve or ascending aortic surgery (64% valvular surgery)</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">USA. Age 66-67; male 69.5%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">617</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 80mg before surgery, 40mg 3hrs before surgery, then 40 mg daily for duration of hospitalisation for statin naïve patients. Patients using statins previously had pre-enrolment statin until the day of surgery, then 80mg atorvastatin the morning of surgery, and 40mg the morning after.</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Placebo. For those given statins previously they were given placebo on day 0 and day 1 (the days that allowed to resume pre-enrolment statins on post-op day 2.</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23% with previous AF</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes - 416/617 were using statins prior to study</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48hrs (unclear)</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Castano 2015<a class="bibr" href="#niceng196er14.ref17" rid="niceng196er14.ref17"><sup>17</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective CABG on-pump</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Spain. Age 65; gender not reported; hypertension 30%; LVEF 64%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pravastatin 40mg 2 hours before anaesthetic induction – one off dose only. A further group using an 80mg one-off dose was also included in the study, but has not been included in this review as it was a non-standard dose, and results were similar to the 40mg dose (meta-analysis sensitivity analysis showed no difference to outcomes in terms of clinical importance)</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Placebo for the one-off dose before anaesthetic induction.</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear, but not in exclusion criteria, so possible</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes - all using chronic statins pre-study. These were resumed as rapidly as possible with the same pre-op dose.</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 days</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Caorsi 2008<a class="bibr" href="#niceng196er14.ref14" rid="niceng196er14.ref14"><sup>14</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective CABG</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Chile. Age 50-80; male 83%; LVEF >35%; NYHA class II or above 26/43</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pravastatin 40mg daily for 9 days, starting 48 hours before surgery until 7<sup>th</sup>post-op day, with one extra dose after surgery.</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Usual care</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear, but not in exclusion criteria, so possible</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear, but not in exclusion criteria, so possible</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 days</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Carrascal 2016<a class="bibr" href="#niceng196er14.ref16" rid="niceng196er14.ref16"><sup>16</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Heart valve surgery</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Spain. Age 66; 66% male;</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">90</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 40mg, starting 7 days before until 7 days after surgery</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No – AF was an exclusion criterion</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No – previous statin therapy an exclusion criterion</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">unclear</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Chello 2006<a class="bibr" href="#niceng196er14.ref20" rid="niceng196er14.ref20"><sup>20</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective CABG</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Italy. Age 64; male 77%; NYHA III 33%; hypertension 45%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 20mg daily starting 21 days before surgery, until an unclear termination time</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear, but not in exclusion criteria, so possible</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear, but not in exclusion criteria, so possible</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36 hours</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dehghani 2015<a class="bibr" href="#niceng196er14.ref29" rid="niceng196er14.ref29"><sup>29</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Isolated heart valve surgery on pump</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Iran. Age 50; 33% male; aortic valve stenosis 52%; mitral valve stenosis 43%; LVEF 45%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 40 mg daily, for 3 days before and 5 days after surgery</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No – AF an exclusion criterion</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No – patients statin naive</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48 hrs</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ji 2009<a class="bibr" href="#niceng196er14.ref43" rid="niceng196er14.ref43"><sup>43</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Isolated CABG</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">China; age 65; male 70%; hypertension 30%; NYHA I-III</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">144</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 20mg for 30 days, starting 7 days pre-surgery.</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No – past AF an exclusion criterion</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No – statins use an exclusion criterion</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30d</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mannacio 2008<a class="bibr" href="#niceng196er14.ref62" rid="niceng196er14.ref62"><sup>62</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective CABG 2-3 grafts only</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Italy. Age 60; 72% male; LVEF >60%: 55%; hypertension 23%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">200</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rosuvastatin 20mg, 7 days pre-surgery. Unclear when terminated.</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear, but not in exclusion criteria, so possible</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No statins in previous 30 days</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 weeks</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Park 2016<a class="bibr" href="#niceng196er14.ref68" rid="niceng196er14.ref68"><sup>68</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective valvular heart surgery</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">South Korea; age 58; 50% male; hypertension 38%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">200</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 80mg evening before surgery, then 40mg on morning of surgery and then 40mg on evenings of post op days 0,1 and 2.</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Haemody namically unstable arrhythmia an exclusion criteria but does not prohibit asymptomatic/mild AF</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No – all statins naive</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30d</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Patti 2006<a class="bibr" href="#niceng196er14.ref70" rid="niceng196er14.ref70"><sup>70</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective CABG with on-pump</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Italy. Age 66; male 74%; hypertension 85%; LVEF 52%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">200</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 40mg daily, starting 3 days pre-surgery and 5 days post-surgery</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No - previous AF was exclusion criterion</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No – exclusion criterion was previous statins use</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30d</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Song 2008<a class="bibr" href="#niceng196er14.ref81" rid="niceng196er14.ref81"><sup>81</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective CABG off pump</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">South Korea. Age 63; male 66%; hypertension 50%; prior MI 10%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">124</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 20mg 3 days before surgery and then for 30 days after surgery</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Usual care</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No previous AF – exclusion criterion</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No – previous statin use exclusion criterion</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30d</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Spadaccio 2010<a class="bibr" href="#niceng196er14.ref82" rid="niceng196er14.ref82"><sup>82</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective CABG</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Italy. Age 65; male 54%; hypertension 50%; NYHA class III or more: 30%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 20mg 3 weeks before surgery. Unclear when terminated</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear, but not in exclusion criteria, so possible</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No cholesterol lowering drugs for 1 year</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 hours</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sun 2011<a class="bibr" href="#niceng196er14.ref84" rid="niceng196er14.ref84"><sup>84</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective CABG</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">China. Age 65; male 67%; hypertension 31%; LVEF 55%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">100</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 20mg every night from 7 days before surgery – unclear when terminated.</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No - arrhythmia an exclusion criterion</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No statins for 2 weeks before treatment</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30 d</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tamayo 2009<a class="bibr" href="#niceng196er14.ref88" rid="niceng196er14.ref88"><sup>88</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective CABG</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Spain. Age 68; male 80%; NYHA class: 2 on average; Increased bp: 22.7% statins and 50% control.</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Simvastatin 20 mg/day. Period unclear</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear if placebo or usual care</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear, but not in exclusion criteria, so possible</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear, but not in exclusion criteria, so possible</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48 hours</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vokovic 2011<a class="bibr" href="#niceng196er14.ref89" rid="niceng196er14.ref89"><sup>89</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective CABG</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serbia. Age 61; male 84%; hypertension 86%; Diabetes 30%; EF <30%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin 20mg daily, for 3 weeks before surgery</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5/57 had AF at baseline</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No cholesterol lowering drugs in past year</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">unclear</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zheng 2016<a class="bibr" href="#niceng196er14.ref100" rid="niceng196er14.ref100"><sup>100</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective CABG (87%) or aortic valve replacement (13%)</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">China. Age 59; male 79%; hypertension 64%; NYHA class III-IV 15%</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1922</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rosuvastatin 20mg for 8 days pre-surgery and 5 days after surgery</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yes</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">In sinus rhythmat randomisation. In supplemental appendix, AF appears to be an exclusion criterion.</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">653/1922 on statin therapy up until randomisation. AF results not sub-grouped.</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 days</td></tr><tr><td headers="hd_h_niceng196er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zhou, 2018<a class="bibr" href="#niceng196er14.ref101" rid="niceng196er14.ref101"><sup>101</sup></a></td><td headers="hd_h_niceng196er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Noncoronary artery cardiac surgery</td><td headers="hd_h_niceng196er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">China. Statin/control: age 41/45 DM 8.6%/5.7%; Dyslipidaemia 37%/37%; hypertension 8.6%/8.6%; stroke 5.7%/8.6%;</td><td headers="hd_h_niceng196er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70</td><td headers="hd_h_niceng196er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Simvastatin 20mg daily for 5-7 days pre-op and then again on day 2 post op</td><td headers="hd_h_niceng196er14.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No</td><td headers="hd_h_niceng196er14.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Placebo</td><td headers="hd_h_niceng196er14.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 in simvastatin group and 3 in control group at baseline</td><td headers="hd_h_niceng196er14.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear</td><td headers="hd_h_niceng196er14.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unclear</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng196er14.tab2_1"><p class="no_margin">Dose required to cause >40% reduction in HDL cholesterol. This dose is 80mg for simvastatin, 20mg for atorvastatin, and 10mg for rosuvastatin. For Pravastatin all licenced doses cause <40% reduction and so all are deemed low intensity (CG181, 2014)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er14tab3"><div id="niceng196er14.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence summary: statins versus placebo or usual care</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571336/table/niceng196er14.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er14.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er14.tab3_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng196er14.tab3_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng196er14.tab3_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng196er14.tab3_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_niceng196er14.tab3_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng196er14.tab3_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng196er14.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng196er14.tab3_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng196er14.tab3_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng196er14.tab3_1_1_1_5" id="hd_h_niceng196er14.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Placebo</th><th headers="hd_h_niceng196er14.tab3_1_1_1_5" id="hd_h_niceng196er14.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Statins (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er14.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">AF post-surgery</td><td headers="hd_h_niceng196er14.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>4421</p><p>(22studies)</p><p>immediate post op until 30 days</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></p><p>due to risk of bias, inconsistency, imprecision</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>Random effects RR 0.65</p><p>(0.53to 0.80)</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_1 hd_h_niceng196er14.tab3_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">317per 1000</td><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>111fewer per 1000</p><p>(from 63fewer to 149fewer)</p></td></tr><tr><td headers="hd_h_niceng196er14.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Health Related Quality of life</td><td headers="hd_h_niceng196er14.tab3_1_1_1_2 hd_h_niceng196er14.tab3_1_1_1_3 hd_h_niceng196er14.tab3_1_1_1_4 hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_1 hd_h_niceng196er14.tab3_1_1_2_2" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">No evidence found</td></tr><tr><td headers="hd_h_niceng196er14.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng196er14.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>3759</p><p>(15 studies)</p><p>immediate post op to 30 days</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>d</sup><sup>,</sup><sup>e</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>RD 0.003</p><p>(0.00 to 0.01)</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_1 hd_h_niceng196er14.tab3_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 1000</td><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>0 fewer per 1000</p><p>(from 0 fewer to 10 more)</p></td></tr><tr><td headers="hd_h_niceng196er14.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Stroke or thromboembolic events</td><td headers="hd_h_niceng196er14.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>3151</p><p>(8 studies)</p><p>up to 30 days</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊝⊝⊝</p><p>VERY LOW<sup>e</sup><sup>,</sup><sup>g</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>RD 0.001</p><p>(−0.01 to 0.01)</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_1 hd_h_niceng196er14.tab3_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19 per 1000</td><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>1 more per 1000</p><p>(from 14 fewer to 14 more)</p></td></tr><tr><td headers="hd_h_niceng196er14.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Hospital readmission</td><td headers="hd_h_niceng196er14.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>200</p><p>(1 study)</p><p>30 days</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊝⊝</p><p>LOW<sup>g</sup></p><p>due to imprecision</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;"><p>RR 0.6</p><p>(0.15 to 2.44)</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_1 hd_h_niceng196er14.tab3_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50 per 1000</td><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>20 fewer per 1000</p><p>(from 43 fewer to 72 more)</p></td></tr><tr><td headers="hd_h_niceng196er14.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hospital length of stay</td><td headers="hd_h_niceng196er14.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>994</p><p>(10 studies)</p><p>30 days</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊝⊝</p><p>LOW<sup>g</sup><sup>,</sup><sup>h</sup></p><p>due to risk of bias, imprecision</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean hospital length of stay in the intervention groups was</p><p>0.54 days lower</p><p>(0.73 days to 0.36 days lower)</p><p>Note: MID was deemed to be 0.7 days (based on 0.5 × median sd [1.4] in placebo group)</p></td></tr><tr><td headers="hd_h_niceng196er14.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ICU length of stay</td><td headers="hd_h_niceng196er14.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>578</p><p>(8 studies)</p><p>30 days</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>⊕⊕⊕⊝</p><p>MODERATE<sup>g</sup></p><p>due to risk of bias</p></td><td headers="hd_h_niceng196er14.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng196er14.tab3_1_1_1_5 hd_h_niceng196er14.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>The mean ICU length of stay in the intervention groups was</p><p>0.1 days lower</p><p>(0.2 days lower to 0 days higher)</p><p>Note: MID was deemed to be 0.35 days (based on 0.5 × median sd [0.69] in placebo group)</p></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng196er14.tab3_1"><p class="no_margin">The majority of evidence was from studies with unclear allocation concealment and unclear assessor blinding. Assessor blinding was felt to be important for this outcome, as detection of AF can be somewhat subjective and prone to bias. Measurement of AF was not clearly described.</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng196er14.tab3_2"><p class="no_margin">Heterogeneity was slightly above the threshold for concern (I squared >50%)</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng196er14.tab3_3"><p class="no_margin">The upper confidence interval exceeded the lower MID of RR=0.8</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng196er14.tab3_4"><p class="no_margin">Most evidence lacked allocation concealment, but was generally free from other significant bias that would influence the outcome of mortality</p></div></dd></dl><dl class="bkr_refwrap"><dt>e</dt><dd><div id="niceng196er14.tab3_5"><p class="no_margin">The OIS was <0.8</p></div></dd></dl><dl class="bkr_refwrap"><dt>f</dt><dd><div id="niceng196er14.tab3_6"><p class="no_margin">The confidence intervals crossed both MIDs at 0.8 and 1.25</p></div></dd></dl><dl class="bkr_refwrap"><dt>g</dt><dd><div id="niceng196er14.tab3_7"><p class="no_margin">The majority of evidence was from studies with few or isolated risks of bias. Lack of assessor blinding was not felt to be important for this outcome.</p></div></dd></dl><dl class="bkr_refwrap"><dt>h</dt><dd><div id="niceng196er14.tab3_8"><p class="no_margin">The confidence intervals crossed within the lower MID at −0.7</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er14tab4"><div id="niceng196er14.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">UK costs of statins</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571336/table/niceng196er14.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er14.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er14.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Drug</th><th id="hd_h_niceng196er14.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Daily dose<sup>(a)</sup></th><th id="hd_h_niceng196er14.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost – per day<sup>(b)</sup></th><th id="hd_h_niceng196er14.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost – per course</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er14.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Atorvastatin tablets</td><td headers="hd_h_niceng196er14.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20-80mg</td><td headers="hd_h_niceng196er14.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.01-£0.04</td><td headers="hd_h_niceng196er14.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.02-£0.61<sup>(c)</sup></td></tr><tr><td headers="hd_h_niceng196er14.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fluvastatin capsules</td><td headers="hd_h_niceng196er14.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">80mg</td><td headers="hd_h_niceng196er14.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.12</td><td headers="hd_h_niceng196er14.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No RCT information</td></tr><tr><td headers="hd_h_niceng196er14.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pravastatin tablets</td><td headers="hd_h_niceng196er14.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10-40mg</td><td headers="hd_h_niceng196er14.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.01-£0.03</td><td headers="hd_h_niceng196er14.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.24<sup>(d)</sup></td></tr><tr><td headers="hd_h_niceng196er14.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rosuvastatin tablets</td><td headers="hd_h_niceng196er14.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10-20mg</td><td headers="hd_h_niceng196er14.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.05-£0.07</td><td headers="hd_h_niceng196er14.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.47<sup>(e)</sup></td></tr><tr><td headers="hd_h_niceng196er14.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Simvastatin tablets</td><td headers="hd_h_niceng196er14.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20-40mg</td><td headers="hd_h_niceng196er14.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.01</td><td headers="hd_h_niceng196er14.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.07<sup>(f)</sup></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Sources: BNF<a class="bibr" href="#niceng196er14.ref12" rid="niceng196er14.ref12"><sup>12</sup></a>; eMIT<a class="bibr" href="#niceng196er14.ref26" rid="niceng196er14.ref26"><sup>26</sup></a> both last accessed January 2020.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng196er14.tab4_1"><p class="no_margin">Daily dose taken from RCTs identified in clinical review, BNF doses for other indications and advice from committee topic adviser.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="niceng196er14.tab4_2"><p class="no_margin">All unit costs sourced from eMIT except for rosuvastatin where source was BNF NHS indicative price. Many manufacturers are available; this is the lowest cost.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(c)</dt><dd><div id="niceng196er14.tab4_3"><p class="no_margin">Multiple RCTs reporting different courses. Price here based on 40mg one off dose from Castano 2015<a class="bibr" href="#niceng196er14.ref17" rid="niceng196er14.ref17"><sup>17</sup></a> and 40mg for 30 days from Aydin 2015<a class="bibr" href="#niceng196er14.ref6" rid="niceng196er14.ref6"><sup>6</sup></a></p></div></dd></dl><dl class="bkr_refwrap"><dt>(d)</dt><dd><div id="niceng196er14.tab4_4"><p class="no_margin">40mg/day for 9 days. Based on Caorsi 2008 <a class="bibr" href="#niceng196er14.ref14" rid="niceng196er14.ref14"><sup>14</sup></a></p></div></dd></dl><dl class="bkr_refwrap"><dt>(e)</dt><dd><div id="niceng196er14.tab4_5"><p class="no_margin">20mg for 7 days pre-surgery. Termination unclear. Based on Mannacio 2008<a class="bibr" href="#niceng196er14.ref62" rid="niceng196er14.ref62"><sup>62</sup></a></p></div></dd></dl><dl class="bkr_refwrap"><dt>(f)</dt><dd><div id="niceng196er14.tab4_6"><p class="no_margin">20mg/day for 7 days preoperatively. Termination unclear. Based on Alamnsob 2012<a class="bibr" href="#niceng196er14.ref2" rid="niceng196er14.ref2"><sup>2</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er14tab5"><div id="niceng196er14.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Elective inpatient excess bed days cost</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571336/table/niceng196er14.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er14.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er14.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Code</th><th id="hd_h_niceng196er14.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Description</th><th id="hd_h_niceng196er14.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Excess Bed Days</th><th id="hd_h_niceng196er14.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">National Average Unit Cost</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er14.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED26A</td><td headers="hd_h_niceng196er14.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Complex Coronary Artery Bypass Graft with CC Score 10+</td><td headers="hd_h_niceng196er14.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34</td><td headers="hd_h_niceng196er14.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£176</td></tr><tr><td headers="hd_h_niceng196er14.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED26B</td><td headers="hd_h_niceng196er14.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Complex Coronary Artery Bypass Graft with CC Score 5-9</td><td headers="hd_h_niceng196er14.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67</td><td headers="hd_h_niceng196er14.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£498</td></tr><tr><td headers="hd_h_niceng196er14.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED26C</td><td headers="hd_h_niceng196er14.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Complex Coronary Artery Bypass Graft with CC Score 0-4</td><td headers="hd_h_niceng196er14.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70</td><td headers="hd_h_niceng196er14.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£343</td></tr><tr><td headers="hd_h_niceng196er14.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED27A</td><td headers="hd_h_niceng196er14.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Major Coronary Artery Bypass Graft with CC Score 10+</td><td headers="hd_h_niceng196er14.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45</td><td headers="hd_h_niceng196er14.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£465</td></tr><tr><td headers="hd_h_niceng196er14.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED27B</td><td headers="hd_h_niceng196er14.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Major Coronary Artery Bypass Graft with CC Score 5-9</td><td headers="hd_h_niceng196er14.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">95</td><td headers="hd_h_niceng196er14.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£354</td></tr><tr><td headers="hd_h_niceng196er14.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED27C</td><td headers="hd_h_niceng196er14.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Major Coronary Artery Bypass Graft with CC Score 0-4</td><td headers="hd_h_niceng196er14.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">115</td><td headers="hd_h_niceng196er14.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£306</td></tr><tr><td headers="hd_h_niceng196er14.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED28A</td><td headers="hd_h_niceng196er14.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard Coronary Artery Bypass Graft with CC Score 10+</td><td headers="hd_h_niceng196er14.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">206</td><td headers="hd_h_niceng196er14.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£283</td></tr><tr><td headers="hd_h_niceng196er14.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED28B</td><td headers="hd_h_niceng196er14.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard Coronary Artery Bypass Graft with CC Score 5-9</td><td headers="hd_h_niceng196er14.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">264</td><td headers="hd_h_niceng196er14.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£377</td></tr><tr><td headers="hd_h_niceng196er14.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED28C</td><td headers="hd_h_niceng196er14.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard Coronary Artery Bypass Graft with CC Score 0-4</td><td headers="hd_h_niceng196er14.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">182</td><td headers="hd_h_niceng196er14.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£356</td></tr><tr><td headers="hd_h_niceng196er14.tab5_1_1_1_1 hd_h_niceng196er14.tab5_1_1_1_2 hd_h_niceng196er14.tab5_1_1_1_3" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;"><b>Weighted average</b></td><td headers="hd_h_niceng196er14.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>£348</b></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: National reference costs 2017-2018<a class="bibr" href="#niceng196er14.ref30" rid="niceng196er14.ref30"><sup>30</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er14tab6"><div id="niceng196er14.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Non-elective inpatient excess bed days cost</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571336/table/niceng196er14.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er14.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er14.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Code</th><th id="hd_h_niceng196er14.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Description</th><th id="hd_h_niceng196er14.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Excess Bed Days</th><th id="hd_h_niceng196er14.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">National Average Unit Cost</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er14.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED26A</td><td headers="hd_h_niceng196er14.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Complex Coronary Artery Bypass Graft with CC Score 10+</td><td headers="hd_h_niceng196er14.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67</td><td headers="hd_h_niceng196er14.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£724</td></tr><tr><td headers="hd_h_niceng196er14.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED26B</td><td headers="hd_h_niceng196er14.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Complex Coronary Artery Bypass Graft with CC Score 5-9</td><td headers="hd_h_niceng196er14.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">354</td><td headers="hd_h_niceng196er14.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£410</td></tr><tr><td headers="hd_h_niceng196er14.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED26C</td><td headers="hd_h_niceng196er14.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Complex Coronary Artery Bypass Graft with CC Score 0-4</td><td headers="hd_h_niceng196er14.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">83</td><td headers="hd_h_niceng196er14.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£352</td></tr><tr><td headers="hd_h_niceng196er14.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED27A</td><td headers="hd_h_niceng196er14.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Major Coronary Artery Bypass Graft with CC Score 10+</td><td headers="hd_h_niceng196er14.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54</td><td headers="hd_h_niceng196er14.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£315</td></tr><tr><td headers="hd_h_niceng196er14.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED27B</td><td headers="hd_h_niceng196er14.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Major Coronary Artery Bypass Graft with CC Score 5-9</td><td headers="hd_h_niceng196er14.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">194</td><td headers="hd_h_niceng196er14.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£300</td></tr><tr><td headers="hd_h_niceng196er14.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED27C</td><td headers="hd_h_niceng196er14.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Major Coronary Artery Bypass Graft with CC Score 0-4</td><td headers="hd_h_niceng196er14.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">339</td><td headers="hd_h_niceng196er14.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£745</td></tr><tr><td headers="hd_h_niceng196er14.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED28A</td><td headers="hd_h_niceng196er14.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard Coronary Artery Bypass Graft with CC Score 10+</td><td headers="hd_h_niceng196er14.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">545</td><td headers="hd_h_niceng196er14.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£232</td></tr><tr><td headers="hd_h_niceng196er14.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED28B</td><td headers="hd_h_niceng196er14.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard Coronary Artery Bypass Graft with CC Score 5-9</td><td headers="hd_h_niceng196er14.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">676</td><td headers="hd_h_niceng196er14.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£434</td></tr><tr><td headers="hd_h_niceng196er14.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ED28C</td><td headers="hd_h_niceng196er14.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard Coronary Artery Bypass Graft with CC Score 0-4</td><td headers="hd_h_niceng196er14.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">446</td><td headers="hd_h_niceng196er14.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£467</td></tr><tr><td headers="hd_h_niceng196er14.tab6_1_1_1_1 hd_h_niceng196er14.tab6_1_1_1_2 hd_h_niceng196er14.tab6_1_1_1_3" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;"><b>Weighted average</b></td><td headers="hd_h_niceng196er14.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>£427</b></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: National reference costs 2017-2018<a class="bibr" href="#niceng196er14.ref30" rid="niceng196er14.ref30"><sup>30</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er14tab7"><div id="niceng196er14.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Critical care cardiac surgical adult patients cost</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571336/table/niceng196er14.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er14.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er14.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Code</th><th id="hd_h_niceng196er14.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Description</th><th id="hd_h_niceng196er14.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Excess Bed Days</th><th id="hd_h_niceng196er14.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">National Average Unit Cost</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er14.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XC01Z</td><td headers="hd_h_niceng196er14.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adult Critical Care, 6 or more Organs Supported</td><td headers="hd_h_niceng196er14.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1,297</td><td headers="hd_h_niceng196er14.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3,071</td></tr><tr><td headers="hd_h_niceng196er14.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XC02Z</td><td headers="hd_h_niceng196er14.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adult Critical Care, 5 Organs Supported</td><td headers="hd_h_niceng196er14.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5,218</td><td headers="hd_h_niceng196er14.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£2,218</td></tr><tr><td headers="hd_h_niceng196er14.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XC03Z</td><td headers="hd_h_niceng196er14.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adult Critical Care, 4 Organs Supported</td><td headers="hd_h_niceng196er14.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19,210</td><td headers="hd_h_niceng196er14.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1,845</td></tr><tr><td headers="hd_h_niceng196er14.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XC04Z</td><td headers="hd_h_niceng196er14.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adult Critical Care, 3 Organs Supported</td><td headers="hd_h_niceng196er14.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45,253</td><td headers="hd_h_niceng196er14.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1,472</td></tr><tr><td headers="hd_h_niceng196er14.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XC05Z</td><td headers="hd_h_niceng196er14.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adult Critical Care, 2 Organs Supported</td><td headers="hd_h_niceng196er14.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58,158</td><td headers="hd_h_niceng196er14.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1,239</td></tr><tr><td headers="hd_h_niceng196er14.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XC06Z</td><td headers="hd_h_niceng196er14.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adult Critical Care, 1 Organ Supported</td><td headers="hd_h_niceng196er14.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43,383</td><td headers="hd_h_niceng196er14.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£898</td></tr><tr><td headers="hd_h_niceng196er14.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XC07Z</td><td headers="hd_h_niceng196er14.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adult Critical Care, 0 Organs Supported</td><td headers="hd_h_niceng196er14.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5,558</td><td headers="hd_h_niceng196er14.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£545</td></tr><tr><td headers="hd_h_niceng196er14.tab7_1_1_1_1 hd_h_niceng196er14.tab7_1_1_1_2 hd_h_niceng196er14.tab7_1_1_1_3" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;"><b>Weighted average</b></td><td headers="hd_h_niceng196er14.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>£1,301</b></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: National reference costs 2017-2018<a class="bibr" href="#niceng196er14.ref30" rid="niceng196er14.ref30"><sup>30</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng196er14tab8"><div id="niceng196er14.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Critical care thoracic surgical adult patients cost</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571336/table/niceng196er14.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng196er14.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng196er14.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Code</th><th id="hd_h_niceng196er14.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Currency Description</th><th id="hd_h_niceng196er14.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Excess Bed Days</th><th id="hd_h_niceng196er14.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">National Average Unit Cost</th></tr></thead><tbody><tr><td headers="hd_h_niceng196er14.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XC01Z</td><td headers="hd_h_niceng196er14.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adult Critical Care, 6 or more Organs Supported</td><td headers="hd_h_niceng196er14.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36</td><td headers="hd_h_niceng196er14.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£2,892</td></tr><tr><td headers="hd_h_niceng196er14.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XC02Z</td><td headers="hd_h_niceng196er14.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adult Critical Care, 5 Organs Supported</td><td headers="hd_h_niceng196er14.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">477</td><td headers="hd_h_niceng196er14.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£2,357</td></tr><tr><td headers="hd_h_niceng196er14.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XC03Z</td><td headers="hd_h_niceng196er14.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adult Critical Care, 4 Organs Supported</td><td headers="hd_h_niceng196er14.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1,232</td><td headers="hd_h_niceng196er14.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£2,172</td></tr><tr><td headers="hd_h_niceng196er14.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XC04Z</td><td headers="hd_h_niceng196er14.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adult Critical Care, 3 Organs Supported</td><td headers="hd_h_niceng196er14.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3,515</td><td headers="hd_h_niceng196er14.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1,896</td></tr><tr><td headers="hd_h_niceng196er14.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XC05Z</td><td headers="hd_h_niceng196er14.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adult Critical Care, 2 Organs Supported</td><td headers="hd_h_niceng196er14.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8,729</td><td headers="hd_h_niceng196er14.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1,433</td></tr><tr><td headers="hd_h_niceng196er14.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XC06Z</td><td headers="hd_h_niceng196er14.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adult Critical Care, 1 Organ Supported</td><td headers="hd_h_niceng196er14.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11,080</td><td headers="hd_h_niceng196er14.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£653</td></tr><tr><td headers="hd_h_niceng196er14.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XC07Z</td><td headers="hd_h_niceng196er14.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adult Critical Care, 0 Organs Supported</td><td headers="hd_h_niceng196er14.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">769</td><td headers="hd_h_niceng196er14.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£300</td></tr><tr><td headers="hd_h_niceng196er14.tab8_1_1_1_1 hd_h_niceng196er14.tab8_1_1_1_2 hd_h_niceng196er14.tab8_1_1_1_3" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;"><b>Weighted average</b></td><td headers="hd_h_niceng196er14.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>£1,182</b></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: National reference costs 2017-2018<a class="bibr" href="#niceng196er14.ref30" rid="niceng196er14.ref30"><sup>30</sup></a></p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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