Author + information
- Justin Ugwu,
- Snehal Shrivastava,
- Tejasvi Sunkara and
- Jonathon Ross
Background: Comprehensive preoperative cardiovascular evaluation is key to prevention of adverse cardiovascular events in the peri-operative period. The American College of Cardiology (ACC) and the American Heart Association (AHA) updated guidelines for preoperative cardiovascular evaluation and management of patients for non-cardiac surgery in 2014. This update includes a “Stepwise Approach to Perioperative Cardiac Assessment (SAPCA)” algorithm. In a busy primary care practice, critical components of the algorithm like metabolic equivalent (METS) and combined clinical/surgical risk may be missed with potential for unnecessary testing. This ongoing study examines the preoperative cardiovascular evaluation process in a primary care setting with emphasis on the utilization of the SAPCA algorithm.
Methods: We are retrospectively reviewing charts of consecutive patients seen in our internal medicine residency clinic for pre-operative cardiovascular evaluation before a planned non-cardiac, non-vascular procedure. Each case is compared to the SAPCA algorithm to determine if any completed cardiovascular testing was appropriate and the common triggers for inappropriate testing. Patients who had surgery in our hospital were followed for occurrence of predefined major adverse cardiovascular events (MACE).
Results: Eighty seven patients were included in this interim analysis. The composite risk of MACE was low in this population with 70% of patients having a risk of 0.9% or less by the revised cardiac risk index (RCRI). Calculation and documentation of METS and composite risk were missing in 93% and 83% of visits respectively which enabled ordering of an electrocardiogram (ECG). Of the 9 cardiac stress tests ordered, 7 (78%) were inappropriate with the most common trigger being an abnormal ECG (67%). We followed 45 patients in the peri-operative period with no incidents of MACE.
Conclusions: Majority of outpatients evaluated pre-operatively for non-cardiac surgery have low risk for MACE. Failure to follow the SAPCA algorithm leads to unnecessary ECG testing which may show abnormalities which then trigger further testing as abnormal ECG's are not addressed in the algorithm.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Diabetes and Other Issues in Cardiovascular Prevention
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1277-068
- 2017 American College of Cardiology Foundation