Key result
Implementation of ACC/AHA guidelines for preoperative cardiac risk assessment reduced exercise stress testing (16.2% vs 30.8%; p<0.001) and improved test appropriateness (94.1% vs 86.0%; p<0.001).
Why the study?
Does implementation of ACC/AHA guidelines for preoperative cardiac risk assessment improve efficiency and preserve outcomes in patients undergoing noncardiac surgery?
Cohort (n=638)
Does implementation of ACC/AHA guidelines for preoperative cardiac risk assessment improve efficiency and preserve outcomes in patients undergoing noncardiac surgery?
Absolute Event Rate: 16.2% vs 30.8%
p-value: p=<0.001
Implementation of ACC/AHA preoperative cardiac risk assessment guidelines in a general medicine clinic improves test appropriateness and efficiency without increasing cardiac complications.
May reduce unnecessary preoperative testing without increasing complications; supports efficiency gains but leaves open causal outcome effects.
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.
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Almanaseer et al. (2004) conducted a cohort in Preoperative evaluation for noncardiac surgery (n=638). Implementation of ACC/AHA guidelines for cardiac risk assessment vs. Prior to guideline implementation (usual care) was evaluated on Exercise stress testing (p=<0.001). Implementation of ACC/AHA guidelines for preoperative cardiac risk assessment reduced exercise stress testing (16.2% vs 30.8%; p<0.001) and improved test appropriateness (94.1% vs 86.0%; p<0.001).
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