Accurate preoperative risk-assessme...

Accurate preoperative risk-assessment tools have been expanded by the American College of Cardiology/American Heart Association (ACC/AHA) and from the American College of Physicians (ACP). These guidelines make recommendations that may terminate in differing noninvasive preoperative cardiac evaluations. Gordon and Macpherson studied the couple most commonly used guidelines for preoperative cardiac evaluation of patients scheduled for elective noncardiac surgery

A retrospective review of a large hospital Medical Preoperative Evaluation Clinic (MPEC) where internists evaluated preoperative risks and arranged preoperative testing, garner uped information about decision-making in this setting. Recommendations of the MPEC physicians were noted and compared with the recommendations of the ACC/AHA or the ACP. Recommendation categories included surgery without testing, noninvasive stres testing, cardiac catheterization, and cancellation or delay of surgery

More stres proofs were ordered by the MPEC physicians than would have been make acceptableed by the ACC/AHA or ACP guidelines. Although guideline recommendations agreed with the decisions for 115 (83 percent) of the 138 patients evaluated, the guidelines did not agree forward a patient's need for a noninvasive example Among patients with an ischemic cardiac history, the guidelines were more concordant in their recommendations.

The authors deduce that the ACC/AHA and ACP guidelines potentially decrease cardiac testing, nevertheless that there is substantial disagreement in the guidelines about which patients require further noninvasive testing. The major reason for this discordance appears to be the ACP evidence-based recommendation that no touchstones are needed in nonvascular surgical patients; the ACC/AHA guideline commends stress testing in patients with gentle functional capacity. There is inadequate evidence to explain this difference. This disagreement negatively affects guideline credibility and may discourage physicians from following guidelines. Physicians ordered more noninvasive stres proofs than were recommended by either guideline. Areas of guideline discordance should be resolv by dint of expert groups that develop recommendations.

Gordon AJ, Macpherson D Guideline chaos: conflicting recommendations for preoperative cardiac assessment. Am J Cardiol June 1 2003;91:1299-303

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