title: Implementation of the ACC/AHA guidelines for preoperative cardiac risk assessment in a general medicine preoperative clinic: improving efficiency and preserving outcomes.
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). 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.
authors.affiliation: The Michigan Cardiovascular Research and Reporting Program, University of Michigan, Ann Arbor, Mich., USA.
authors.forename: Yassar
authors.initials: Y
authors.lastname: Almanaseer
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Eva M
authors.initials: EM
authors.lastname: Kline-Rogers
authors.forename: Sean K
authors.initials: SK
authors.lastname: Kesterson
authors.forename: Seema S
authors.initials: SS
authors.lastname: Sonnad
authors.forename: Bruce
authors.initials: B
authors.lastname: Rogers
authors.forename: Dean
authors.initials: D
authors.lastname: Smith
authors.forename: Scott
authors.initials: S
authors.lastname: Furney
authors.forename: Robert
authors.initials: R
authors.lastname: Ernst
authors.forename: Jane
authors.initials: J
authors.lastname: McCort
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
mesh_terms: 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
chemical_list: D000319:Adrenergic beta-Antagonists; D013794:Thallium Radioisotopes