title: Adherence of French cardiologists to guidelines for non-cardiac surgery.
abstract: BACKGROUND
  In order to evaluate whether cardiologists follow guidelines, we studied patients who were seen for a preoperative cardiologic consultation prior to surgery.
  
  
  METHODS
  This retrospective study took place in two surgical units (Vascular and Orthopaedic) in two different university hospitals in 2013. The patient eligibility criteria were: planned elective surgery, cardiologic consultation prior to anaesthesiology consultation and lack of any unstable cardiac condition. The primary endpoint was determination of appropriate use of preoperative cardiac stress exams (CSE).
  
  
  RESULTS
  The study included 238 patients who were seen by 131 different cardiologists. Of 238 patients, 60 had a CSE before surgery, but only 7/60 (12%) were deemed to be necessary. Seven out 15 (47%) patients with an indication for a CSE actually underwent said exam. Sixty-six percent of patients (156/238) had a resting trans-thoracic echocardiography before surgery, while only 27/156 (17%) were considered of appropriate use. Among patients with known coronary arterial disease, 59/73 (81%) received a statin, 60/73 (82%) received an antiplatelet agent, and 38/73 (52%) received a beta-blocker. Among patients with planned arterial surgery, 86/137 (63%) received a statin and 100/137 (73%) patients received an antiplatelet agent. Of the 159 consultation reports that were examined, only 5 (3%) mentioned the Lee score and 117 (74%) were concluded with "no contraindication" or a similar phrase.
  
  
  CONCLUSIONS
  In this study, we found that guidelines were generally not used when cardiologists evaluated patients for non-cardiac surgery. This is evidenced by the number of inappropriate exams performed, the lack of true perioperative risk stratification, and incomplete optimization of long-term treatment regimens.
authors.affiliation: Department of anaesthesiology and intensive care, Louis-Pradel hospital, hospices civils de Lyon, 28, avenue du Doyen-Lepine, 69677 Bron, France. Electronic address: remi.schweizer@gmail.com.
authors.forename: Rémi
authors.initials: R
authors.lastname: Schweizer
authors.affiliation: Department of anaesthesiology and intensive care II, Pontchaillou university hospital, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Godet
authors.affiliation: Department of anaesthesiology and intensive care, Lyon-Sud hospital, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Benite, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Petit
authors.affiliation: Department of anaesthesiology and intensive care, Louis-Pradel hospital, hospices civils de Lyon, 28, avenue du Doyen-Lepine, 69677 Bron, France.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Elia
authors.affiliation: Department of anaesthesiology and intensive care II, Pontchaillou university hospital, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Guette
authors.affiliation: Interventional cardiology department, Louis-Pradel hospital, hospices civils de Lyon, 28, avenue du Doyen-Lepine, 69677 Bron, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: Finet
authors.affiliation: Department of anaesthesiology and intensive care, Louis-Pradel hospital, hospices civils de Lyon, 28, avenue du Doyen-Lepine, 69677 Bron, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Fellahi
authors.affiliation: Department of anaesthesiology and intensive care, Lyon-Sud hospital, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Benite, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Piriou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072080:Anesthesiologists; D000072096:Cardiologists; D023381:Endpoint Determination; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006331:Heart Diseases / Q000150:complications / Q000628:therapy; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D011300:Preoperative Care / Q000592:standards* / Q000706:statistics & numerical data; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000379:methods*; D014656:Vascular Surgical Procedures / Q000379:methods
keywords: Coronary artery disease; Guideline adherence; Non-cardiac surgery; Preoperative evaluation