title: American College of Cardiology/American Heart Association perioperative assessment guidelines for noncardiac surgery reduces cardiologic resource utilization preserving a favourable clinical outcome.
abstract: OBJECTIVE
  The American College of Cardiology (ACC) and the American Heart Association (AHA) provided perioperative evaluation and management guidelines for assessing cardiac risk in noncardiac surgery. Even if previously validated as safe and effective in risk stratification, there is often a gap between clinical practice and the recommendations of the ACC/AHA guidelines. We evaluated the impact of strict application of ACC/AHA guidelines for cardiac risk assessment of patients undergoing elective noncardiac vascular surgery in a consultant anaesthesiologist-led preoperative clinic.
  
  
  METHODS
  One hundred and sixty-four consecutive patients who underwent elective vascular surgery after ACC/AHA guidelines implementation (from September 2004 to May 2005) were enrolled in the study and compared with a historical group of 166 patients operated from April 2002 to September 2002. Preoperative resources utilization (cardiologic consultations, non-invasive diagnostic tests, coronary angiograms, coronary revascularizations) and clinical events [all-cause death, acute myocardial infarction (AMI) and acute myocardial ischaemia] occurring within 30 days after surgical procedure were compared.
  
  
  RESULTS
  Guidelines implementation reduced preoperative cardiologic consultations by 21% (P < 0.001) and preoperative non-invasive diagnostic testing by 11% (P = 0.01), and increased utilization of preoperative beta-blockers by 13% (P = 0.01). Preoperative coronary angiograms (2% versus 4%) and coronary revascularizations (3% versus 2%) and all-cause death (1% versus 2%), AMI (2% versus 1%) and acute myocardial ischaemia (4% versus 2%) during follow-up were similar in both groups.
  
  
  CONCLUSIONS
  Implementation of the ACC/AHA guidelines for cardiac risk assessment prior to noncardiac surgery in a consultant anaesthesiologist-led preoperative clinic reduced preoperative resources utilization, improved medical treatment and preserved a low rate of perioperative cardiac complications.
authors: Cardiology Unit, Cardiopulmonary Science Department, Azienda Ospedaliero-Universitaria di Udine, Piazzale Santa Maria della Misericordia 15, Udine, Italy.
authors: Margherita
authors: M
authors: Cinello
authors: Gaetano
authors: G
authors: Nucifora
authors: Massimo
authors: M
authors: Bertolissi
authors: Luigi P
authors: LP
authors: Badano
authors: Claudio
authors: C
authors: Fresco
authors: Nevio
authors: N
authors: Gonano
authors: Paolo M
authors: PM
authors: Fioretti
mesh_terms: D000465:Algorithms; D017558:Elective Surgical Procedures; D006331:Heart Diseases / Q000517:prevention & control*; D006801:Humans; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012955:Societies, Medical; D014656:Vascular Surgical Procedures