Key result
Routine preoperative practice poorly matches ACC/AHA guidelines, yielding unnecessary echocardiograms in ~82% of cases.
Why the study?
There is a need to identify gaps between actual clinical practice and the ACC/AHA 2007 guidelines for preoperative cardiac assessment before non-cardiac surgery.
Does actual clinical practice for preoperative cardiac assessment align with ACC/AHA 2007 guidelines in patients undergoing non-cardiac surgery?
Observational (n=100)
No
Does actual clinical practice for preoperative cardiac assessment align with ACC/AHA 2007 guidelines in patients undergoing non-cardiac surgery?
There is a significant gap between actual clinical practice and ACC/AHA 2007 guidelines for preoperative cardiac assessment, characterized by the frequent unnecessary use of echocardiography.
Answers are grounded in this paper and cite their sources.
Highlights substantial preoperative guideline discordance; leaves open whether targeted education or protocols improve adherence or outcomes.
Background and Aims: American College of Cardiology (ACC) and American Heart Association (AHA) have issued revised guidelines in 2007 for pre operative assessment of cardiac patients before non-cardiac surgery.We studied the pattern of practice for assessment of cardiac patients for non-cardiac surgery at our centre to find gap in existing practice from the ACC/AHA 2007 perioperative guidelines.Methods: We evaluated 100 consecutive case records of patients undergoing non-cardiac surgery referred to department of Medicine for preoperative assessment of cardiac problem.We analyzed clinical notes of anaesthesiologists and physicians to identify pattern of practice and analyze if the surgical team proceeded for surgery or physician requested further investigations like ECG, Echocardiography or TMT (Tread Mill Test) before proceeding to surgery.Results: We observed that emergency surgeries, active cardiac conditions and major cardiac risk factors were identified in all patients (100%) as per guidelines.All surgeries (100%) were not categorised according to risk.ECG was not necessary but advised in 13(13%) out of 100 patients and echocardiography was advised in 49 patients, out of which 40(81.6%) were not necessary.From the kappa statistic calculation, there was poor agreement between the guidelines and actual practice of advising Echocardiography (kappa value = 0.167).Conclusion: We found that there is significant gap in actual clinical practice and the recommendations of ACC/AHA 2007 guidelines on preoperative assessment of cardiac patients for non-cardiac surgery at our institute.We recommend development and application of guidelines on preoperative assessment of cardiac patients for non-cardiac surgery appropriate for our setting.
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Parekh et al. (2017) conducted an observational in Cardiac patients undergoing non-cardiac surgery (n=100). Adherence to ACC/AHA 2007 guidelines vs. Actual clinical practice was evaluated on Agreement between ACC/AHA guidelines and actual practice of advising echocardiography (kappa = 0.167). Actual clinical practice showed poor agreement with ACC/AHA 2007 guidelines, resulting in unnecessary echocardiography being advised in 81.6% of cases.
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