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Table of Contents
Vol. 103, No. 1, 2005
Issue release date: November 2004
Section title: General Cardiology
Cardiology 2005;103:24–29
(DOI:10.1159/000081848)

Implementation of the ACC/AHA Guidelines for Preoperative Cardiac Risk Assessment in a General Medicine Preoperative Clinic: Improving Efficiency and Preserving Outcomes

Almanaseer 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

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Article / Publication Details

First-Page Preview
Abstract of General Cardiology

Received: March 31, 2004
Accepted: April 05, 2004
Published online: November 24, 2004
Issue release date: November 2004

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 5

ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)

For additional information: http://www.karger.com/CRD

Abstract

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.

© 2005 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of General Cardiology

Received: March 31, 2004
Accepted: April 05, 2004
Published online: November 24, 2004
Issue release date: November 2004

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 5

ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)

For additional information: http://www.karger.com/CRD


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