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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: 3/31/2004
Accepted: 4/5/2004
Published online: 11/24/2004

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.


Article / Publication Details

First-Page Preview
Abstract of General Cardiology

Received: 3/31/2004
Accepted: 4/5/2004
Published online: 11/24/2004

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


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Eagle KA, Brundage BH, Chaitman BR, Ewy GA, Fleisher LA, Hertzer NR, Leppo JA, Ryan T, Schlant RC, Spencer WH 3rd, Spittell JA Jr, Twiss RD, Ritchie JL, Cheitlin MD, Gardner TJ, Garson A Jr, Lewis RP, Gibbons RJ, O’Rourke RA, Ryan TJ: Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. J Am Coll Cardiol 1996;27:910–948.
  2. Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, Fleisher LA, Froehlich JB, Gusberg RJ, Leppo JA, Ryan T, Schlant RC, Winters WL Jr, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Jacobs AK, Hiratzka LF, Russell RO, Smith SC Jr: ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery. J Am Coll Cardiol 2002;39:542–553.
  3. Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, Burke DS, O’Malley TA, Goroll AH, Caplan CH, Nolan J, Carabello B, Slater EE: Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977;297:845–850.
  4. Detsky AS, Abrams HB, McLaughlin JR, Drucker DJ, Sasson Z, Johnston N, Scott JG, Forbath N, Hilliard JR: Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med 1986;1:211–219.
  5. Detsky AS, Abrams HB, Forbath N, Scott JG, Hilliard JR: Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index. Arch Intern Med 1986;146:2131–2134.
  6. Eagle KA, Coley CM, Newell JB, Brewster DC, Darling RC, Strauss HW, Guiney TE, Boucher CA: Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med 1989;110:859–866.
  7. L’Italien GJ, Paul SD, Hendel RC, Leppo JA, Cohen MC, Fleisher LA, Brown KA, Zarich SW, Cambria RP, Cutler BS, Eagle KA: Development and validation of a Bayesian model for perioperative cardiac risk assessment in a cohort of 1,081 vascular surgical candidates. J Am Coll Cardiol 1996;27:779–786.
  8. Poldermans D, Fioretti PM, Forster T, Thomson IR, Boersma E, el-Said EM, du Bois NA, Roelandt JR, van Urk H: Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery. Circulation 1993;87:1506–1512.
  9. Boersma E, Poldermans D, Bax JJ, Steyerberg EW, Thomson IR, Banga JD, van De Ven LL, van Urk H, Roelandt JR: Predictors of cardiac events after major vascular surgery: Role of clinical characteristics, dobutamine echocardiography, and beta-blocker therapy. JAMA 2001;285:1865–1873.
  10. Fleisher LA, Eagle KA: Clinical practice. Lowering cardiac risk in noncardiac surgery. N Engl J Med 2001;345:1677–1682.
  11. Mukherjee D, Eagle KA: Perioperative cardiac assessment for noncardiac surgery: Eight steps to the best possible outcome. Circulation 2003;107:2771–2774.
  12. Rubin DN, Ballal RS, Marwick TH: Outcomes and cost implications of a clinical-based algorithm to guide the discriminate use of stress imaging before noncardiac surgery. Am Heart J 1997;134:83–92.
  13. Shaw LJ, Hachamovitch R, Cohen M, Berman DS, Borges-Neto S, Udelson JE, Heller GV, Eisenstein EL, Eagle KA, Hendel RC, Miller DD: Cost implications of selective preoperative risk screening in the care of candidates for peripheral vascular operations. Am J Manag Care 1997;3:1817–1827.
  14. Eagle KA, Lee TH, Brennan TA, Krumholz HM, Weingarten S: 28th Bethesda Conference. Task Force 2: Guideline Implementation. J Am Coll Cardiol 1997;29:1141–1148.
  15. Pearson SD, Goulart-Fisher D, Lee TH: Critical pathways as a strategy for improving care: Problems and potential. Ann Intern Med 1995;123:941–948.
  16. Mehta RH, Montoye CK, Gallogly M, Baker P, Blount A, Faul J, Roychoudhury C, Borzak S, Fox S, Franklin M, Freundl M, Kline-Rogers E, LaLonde T, Orza M, Parrish R, Satwicz M, Smith MJ, Sobotka P, Winston S, Riba AA, Eagle KA: Improving quality of care for acute myocardial infarction: The Guidelines Applied in Practice (GAP) Initiative. JAMA 2002;287:1269–1276.
  17. Berwick DM: A primer on leading the improvement of systems. BMJ 1996;312:619–622.
  18. Eagle KA, Gallogly M, Mehta RH, Baker PL, Blount A, Freundl M, Orza MJ, Parrish R, Riba AL, Montoye CK: Taking the national guideline for care of acute myocardial infarction to the bedside: Developing the guideline applied in practice (GAP) initiative in Southeast Michigan. Jt Comm J Qual Improv 2002;28:5–19.

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