Implementation of the ACC/AHA Guidelines for Preoperative Cardiac Risk Assessment in a General Medicine Preoperative Clinic: Improving Efficiency and Preserving OutcomesAlmanaseer Y. · Mukherjee D. · Kline-Rogers E.M. · Kesterson S.K. · Sonnad S.S. · Rogers B. · Smith D. · Furney S. · Ernst R. · McCort J. · Eagle K.A.
The Michigan Cardiovascular Research and Reporting Program, University of Michigan, Ann Arbor, Mich., USA
Background: The American College of Cardiology/American Heart Association (ACC/AHA) publishes recommendations for cardiac assessment of patients undergoing noncardiac surgery with the intent of promoting evidence-based, efficient preoperative screening and management. We sought to study the impact of guideline implementation for cardiac risk assessment in a general internal medicine preoperative clinic. Methods: The study was an observational cohort study of consecutive patients being evaluated in an outpatient preoperative evaluation clinic before and after implementation of the ACC/AHA guideline. Data was gathered by retrospective abstraction of hospital and clinic charts using standard definitions. 299 patients were reviewed prior to guideline implementation and their care compared to 339 consecutive patients after the guideline was implemented in the clinic. Results: Guideline implementation led to a reduction in exercise stress testing (30.8% before, 16.2% after; p < 0.001) and hospital length of stay (6.5 days before, 5.6 days after; p = 0.055). β-Blocker therapy increased after the intervention (15.7% before; 34.5% after; p < 0.001) and preoperative test appropriateness improved (86% before to 94.1% after; p < 0.001). Conclusions: Implementation of the ACC/AHA guidelines for cardiac risk assessment prior to noncardiac surgery in an internal medicine preoperative assessment clinic led to a more appropriate use of preoperative stress testing and β-blocker therapy while preserving a low rate of cardiac complications.
Debabrata Mukherjee, MD
Tyler Gill Professor of Interventional Cardiology
Gill Heart Institute, Division of Cardiovascular Medicine, University of Kentucky
900 S. Limestone Street, 326 Wethington Building, Lexington KY 40536–0200 (USA)
Tel. + 1 859 323 5630, Fax +1 859 323 6475, E-Mail Mukherjee@uky.edu
This study was funded by grant 217-II from the Blue Cross Blue Shield of Michigan Foundation.
Received: March 31, 2004
Accepted: April 5, 2004
Published online: November 3, 2004
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 5, Number of References : 18
Cardiology (International Journal of Cardiovascular Medicine, Surgery and Pathology)
Vol. 103, No. 1, Year 2005 (Cover Date: Released November 2004)
Journal Editor: J.S. Alpert, Tucson, Ariz.
ISSN: 0008–6312 (print), 1421–9751 (Online)
For additional information: http://www.karger.com/crd