Implementation of the ACC/AHA guidelines for preoperative cardiac risk assessment in a general medicine preoperative clinic: improving efficiency and preserving outcomes.
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). beta-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 beta-blocker therapy while preserving a low rate of cardiac complications.
Almanaseer
Yassar
Y
The Michigan Cardiovascular Research and Reporting Program, University of Michigan, Ann Arbor, Mich., USA.
Mukherjee
Debabrata
D
Kline-Rogers
Eva M
EM
Kesterson
Sean K
SK
Sonnad
Seema S
SS
Rogers
Bruce
B
Smith
Dean
D
Furney
Scott
S
Ernst
Robert
R
McCort
Jane
J
Eagle
Kim A
KA
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D015331:Cohort Studies; D025401:Echocardiography, Stress / Q000706:statistics & numerical data; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D011183:Postoperative Complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000592:standards; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D013794:Thallium Radioisotopes
D000319:Adrenergic beta-Antagonists; D013794:Thallium Radioisotopes