Cardiac risk stratification for noncardiac surgery: Update from the American College of Cardiology/American Heart Association 2007 guidelines

2009 ◽  
Vol 76 (10 suppl 4) ◽  
pp. S9-S15 ◽  
Author(s):  
Lee A. Fleisher
Keyword(s):  
Risk Stratification ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Cardiac Risk ◽  
Noncardiac Surgery

scholarly journals Effect of β-blocker Prescription on the Incidence of Postoperative Myocardial Infarction after Hip and Knee Arthroplasty

2009 ◽  
Vol 111 (4) ◽  
pp. 717-724 ◽  
Author(s):  
Wilton A. van Klei ◽  
Gregory L. Bryson ◽  
Homer Yang ◽  
Alan J. Forster
Keyword(s):  
Myocardial Infarction ◽  
Beta Blocker ◽  
Odds Ratio ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Noncardiac Surgery ◽  
Beta Blockade ◽  
Intermediate Risk ◽  
Postoperative Myocardial Infarction

Background American College of Cardiology/American Heart Association guidelines recommend beta-blockade for selected low- and intermediate-risk noncardiac surgery patients. The authors evaluated the effect of perioperative beta-blockade on postoperative myocardial infarction (POMI) in low-risk patients undergoing intermediate-risk surgery. Methods Patients who underwent elective hip or knee arthroplasty between January 1, 2002 and June 30, 2006 were identified. POMI was defined as a Troponin T value of more than 0.1 ng . ml(-1). Patients were divided into three groups: those prescribed a beta-blocker on the day of surgery and throughout their hospital stay (or 7 days, whichever came first), those prescribed a beta-blocker on the day of surgery but discontinued during the first 7 days, and those not prescribed a beta-blocker on the day of surgery. Propensity analysis and logistic regression were used to determine the independent association of beta-blocker exposure on POMI. Results Of the 5,158 arthroplasty patients, 992 (18%) were treated with beta-blockers on the day of surgery. This beta-blocker was discontinued in 252 patients (25%). POMI occurred in 77 patients (1.5%). Discontinuation of beta-blocker prescription was significantly associated with POMI (odds ratio 2.0; 95% CI 1.1-3.9) and death (odds ratio 2.0; 95% CI 1.0-3.9). Conclusion After adjustment for confounders, discontinuation of beta-blocker prescription during the first week after surgery was significantly associated with POMI and death. These findings confirm the American College of Cardiology/American Heart Association Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery, which recommend not to withdraw beta-blocker therapy.

Improving Preoperative Cardiac Assessment Efficiency by Using the American College of Cardiology/American Heart Association Guidelines: A Quality Improvement Project

2015 ◽  
Vol 8 (2) ◽  
pp. 164-171
Author(s):  
Marcia A. Zuzul ◽  
Paula Tanabe ◽  
Robert Blok ◽  
Kenneth Snyder
Keyword(s):  
Quality Improvement ◽  
American Heart Association ◽  
American Heart ◽  
Guideline Implementation ◽  
Heart Association ◽  
Noncardiac Surgery ◽  
Assessment Process ◽  
Cardiac Complications ◽  
Evidence Based ◽  
Improvement Project

Background: Patients undergoing noncardiac surgery can experience cardiac complications, which are a major cause of morbidity and mortality in the perioperative period. The goal of this quality improvement (QI) project was to standardize the preoperative assessment process and improve patient-centered care by implementing evidence-based practice guidelines for electrocardiogram (ECG) recommendations prior to noncardiac surgery. Methods: Three steps were used to implement the American College of Cardiology/American Heart Association (ACC/AHA) recommendation for ECG to reduce variance in practice and decrease surgical cancellations. A pre- and postdesign was used to evaluate 2 outcomes: decreased surgical cancellations for lack of a current ECG and surgical loss opportunity cost. All data were retrospectively collected for 60 days during the pre- and postperiods. Results: Evidence-based, preoperative ECG recommendations were implemented in the electronic medical record (EMR). Overall, ECG guideline adherence increased from 50% to 66% (χ2 = 2.19, p = .139) postimplementation. Surgical cancellations because of unmet ECG requirements were reduced from 50% to 34% (χ2 = 2.19, p = .139) post-EMR guideline implementation. There was no statistical difference in the cost associated with loss surgical opportunity minutes between the periods (t = 0.79, p = .43, 95% CI [−6.96, 16.24]). Discussion: We successfully implemented an evidence-based guideline recommending specific preoperative ECG requirements within a busy Veterans Administration hospital. This project stimulated ongoing dialogue between the disciplines with positive trends in decreased surgical cancellations.

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