Key result
Adherence to ACC/AHA guidelines for preoperative cardiac assessment was poor, with testing performed in only 21% of recommended cases, whereas guidelines were followed in 89% of non-recommended cases.
Why the study?
Does clinical practice adhere to ACC/AHA guidelines for preoperative cardiac assessment in peripheral vascular surgery patients?
Observational (n=711)
Yes
Does clinical practice adhere to ACC/AHA guidelines for preoperative cardiac assessment in peripheral vascular surgery patients?
Absolute Event Rate: 21% vs 89%
Clinical practice shows poor adherence to ACC/AHA guidelines for preoperative cardiac assessment in vascular surgery patients, with only 21% of indicated patients receiving recommended noninvasive testing.
Low adherence to preoperative testing guidelines in vascular surgery patients warrants targeted quality improvement; leaves open whether better compliance affects outcomes.
BACKGROUND: The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery recommend an algorithm for a stepwise approach to preoperative cardiac assessment in vascular surgery patients. The authors' main objective was to determine adherence to the ACC/AHA guidelines on perioperative care in daily clinical practice. METHODS: Between May and December 2004, data on 711 consecutive peripheral vascular surgery patients were collected from 11 hospitals in The Netherlands. This survey was conducted within the infrastructure of the Euro Heart Survey Programme. The authors retrospectively applied the ACC/AHA guideline algorithm to each patient in their data set and subsequently compared observed clinical practice data with these recommendations. RESULTS: Although 185 of the total 711 patients (26%) fulfilled the ACC/AHA guideline criteria to recommend preoperative noninvasive cardiac testing, clinicians had performed testing in only 38 of those cases (21%). Conversely, of the 526 patients for whom noninvasive testing was not recommended, guidelines were followed in 467 patients (89%). Overall, patients who had not been tested, irrespective of guideline recommendation, received less cardioprotective medications, whereas patients who underwent noninvasive testing were significantly more often treated with cardiovascular drugs (beta-blockers 43% vs. 77%, statins 52% vs. 83%, platelet inhibitors 80% vs. 85%, respectively; all P < 0.05). Moreover, the authors did not observe significant differences in cardiovascular medical therapy between patients with a normal test result and patients with an abnormal test result. CONCLUSION: This survey showed poor agreement between ACC/AHA guideline recommendations and daily clinical practice. Only one of each five patients underwent noninvasive testing when recommended. Furthermore, patients who had not undergone testing despite recommendations received as little cardiac management as the low-risk population.
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Hoeks et al. (2007) conducted an observational in Peripheral vascular surgery (n=711). ACC/AHA guideline recommendation for preoperative noninvasive cardiac testing vs. No recommendation for testing was evaluated on Adherence to ACC/AHA guidelines (performance or omission of testing as recommended). Adherence to ACC/AHA guidelines for preoperative cardiac assessment was poor, with testing performed in only 21% of recommended cases, whereas guidelines were followed in 89% of non-recommended cases.
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