ACC/AHA guidelines for preoperative cardiovascular evaluation for noncardiac surgery: A critical point of view

Abstract

Summary: This review examines the issue of preoperative cardiac evaluation from a critical point of view, based on recent medical literature. We reviewed the history of that field and focused on the American College of Cardiology and American Heart Association guidelines, which are a cornerstone in the field of cardiac patients undergoing noncardiac surgery. These guidelines synthesized the data into a comprehensive format and established the concept of integrating the patient's risk with the surgical risk. Nevertheless, there are some weaknesses in the guidelines. We believe that a better understanding of the guideline limitations will allow an improved and more educated practice of its recommendations.

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

“…Arora et al (2011) noted the adherence to published screening guidelines significantly reduces the cost of patient care. Some practitioners feel current guidelines, in general, are inconsistent and cumbersome, which can lead to a lack of adherence and implementation (Arora et al, 2011;Barak, Ben-Abraham, & Katz, 2006;Poldermans et al, 2009). Although these guidelines do have strengths and weaknesses, they are an excellent tool for practitioners to guide the preoperative cardiac assessment for noncardiac surgeries (Barak et al, 2006;Williams & Bergin, 2009).…”

“…Some practitioners feel current guidelines, in general, are inconsistent and cumbersome, which can lead to a lack of adherence and implementation (Arora et al, 2011;Barak, Ben-Abraham, & Katz, 2006;Poldermans et al, 2009). Although these guidelines do have strengths and weaknesses, they are an excellent tool for practitioners to guide the preoperative cardiac assessment for noncardiac surgeries (Barak et al, 2006;Williams & Bergin, 2009). An important consideration is that adherence and implementation of clinical practice guidelines has been shown to decrease patient health care costs (Arora et al, 2011;Barak et al, 2006).…”

“…Although these guidelines do have strengths and weaknesses, they are an excellent tool for practitioners to guide the preoperative cardiac assessment for noncardiac surgeries (Barak et al, 2006;Williams & Bergin, 2009). An important consideration is that adherence and implementation of clinical practice guidelines has been shown to decrease patient health care costs (Arora et al, 2011;Barak et al, 2006). First, practitioners must be aware of the guidelines' existence.…”

“…The accessibility of the ACC/ AHA guidelines as a cardiac decision tool strengthens the argument for its use. Some researchers argue that decreased adherence is because of inconsistent recommendations, rather than lack of knowledge of the guidelines (Barak et al, 2006). Adherence to guidelines may be dependent on the convenience of use in clinical practice (DeHert, 2009).…”

Statins and perioperative myocardial infarction

“…Such intervention is of doubtful benefit. [2][3][4][5][6] Less invasive interventions such as percutaneous coronary angioplasty, and/or coronary stenting, initially promised better perioperative outcomes. Subsequent experience has taught that a high risk of perioperative thrombosis and occlusion exists if non-cardiac surgery is performed within the first 35 days, and probably longer, after coronary stent placement.…”