Adherence to Clinical Quidelines on Preoperative Assessment and Correction of Cardiovascular Risk in Non-cardiac Surgery
Surgical care is associated with a high risk of complications. In 2014 the updated joint ESC/ESA guidelines on preoperative assessment and perioperative management of patients were published to improve patient safety in non-cardiac surgery. The increase in the adherence to clinical guidelines promot...
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| Format: | Article |
| Language: | English |
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Столичная издательская компания
2020-12-01
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| Series: | Рациональная фармакотерапия в кардиологии |
| Subjects: | |
| Online Access: | https://www.rpcardio.online/jour/article/view/2353 |
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| author | M. D. Nigmatkulova E. B. Kleymenova L. P. Yashina V. A. Otdelenov S. A. Payushchik O. D. Konova D. A. Sychev |
| author_facet | M. D. Nigmatkulova E. B. Kleymenova L. P. Yashina V. A. Otdelenov S. A. Payushchik O. D. Konova D. A. Sychev |
| author_sort | M. D. Nigmatkulova |
| collection | DOAJ |
| description | Surgical care is associated with a high risk of complications. In 2014 the updated joint ESC/ESA guidelines on preoperative assessment and perioperative management of patients were published to improve patient safety in non-cardiac surgery. The increase in the adherence to clinical guidelines promotes the improving of the healthcare quality and safety improvement.Aim. To study physicians' level of adherence to ESC/ESA clinical guidelines for preoperative assessment and perioperative management of patients.Material and methods. A retrospective observational study included 102 patients admitted to Moscow general hospital from 01.03.2019 to 30.06.2018 for elective surgery. All of them underwent preoperative examination in outpatient department of the hospital and had at least one concomitant disease requiring drug therapy. The medical records data on the preoperative examination and perioperative treatment with beta-blockers, HMG CoA reductase inhibitors and angiotensin-converting-enzyme (ACE) inhibitors/ angiotensin receptor blockers (ARBs) were analyzed for compliance with the ESC/ESA guidelines.Results. A standardized cardiac risks assessment was not documented in the results of preoperative examination. Electrocardiography (ECG), echocardiography and non-invasive stress tests were performed according to clinical guidelines in 100%, 77.8% and 25% of cases, respectively. Unnecessary ECG and echocardiography were prescribed in 50.5% and 72% of cases, respectively. Appropriate correction of ACE inhibitors/ARBs therapy was performed in 66.7% patients with congestive heart failure and only in 2.7% with arterial hypertension. In 19 patients with ischemic cardiac disease, 13 (84.2%) patients received HMG CoA reductase inhibitors and 16 (68.4%) ones received beta-blockers during hospitalization. Inappropriate omission of statins, beta-blockers and ACE inhibitors (ARBs) during hospitalization was registered in 22.2%, 11% and 4.9% patients, respectively.Conclusion. The number of inappropriate ECGs and echocardiographies, as well as incorrect treatment with beta-blockers, HMG CoA reductase inhibitors and ACE inhibitors (ARBs) in perioperative period evidence that the adherence of physicians to the clinical guidelines on preoperative assessment and perioperative management of patients remains low.It is reasonably to develop risk-based interdisciplinary protocols for preoperative examination, algorithms for interdisciplinary communication and interaction between specialists and the healthcare levels, as well as physicians' education for better adherence to clinical guidelines. |
| first_indexed | 2024-03-08T14:00:50Z |
| format | Article |
| id | doaj.art-28837af9fd0041908e59214579d86331 |
| institution | Directory Open Access Journal |
| issn | 1819-6446 2225-3653 |
| language | English |
| last_indexed | 2025-02-17T22:16:11Z |
| publishDate | 2020-12-01 |
| publisher | Столичная издательская компания |
| record_format | Article |
| series | Рациональная фармакотерапия в кардиологии |
| spelling | doaj.art-28837af9fd0041908e59214579d863312024-12-04T11:48:19ZengСтоличная издательская компанияРациональная фармакотерапия в кардиологии1819-64462225-36532020-12-0116688188710.20996/1819-6446-2020-12-111824Adherence to Clinical Quidelines on Preoperative Assessment and Correction of Cardiovascular Risk in Non-cardiac SurgeryM. D. Nigmatkulova0E. B. Kleymenova1L. P. Yashina2V. A. Otdelenov3S. A. Payushchik4O. D. Konova5D. A. Sychev6General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional EducationGeneral Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education; Institute of Modern Information Technologies in Medicine, Federal Research Center “Computer Science and Control” of the Russian Academy of SciencesGeneral Medical Center of the Bank of Russia; Institute of Modern Information Technologies in Medicine, Federal Research Center “Computer Science and Control” of the Russian Academy of SciencesGeneral Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional EducationGeneral Medical Center of the Bank of RussiaGeneral Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional EducationRussian Medical Academy of Continuing Professional EducationSurgical care is associated with a high risk of complications. In 2014 the updated joint ESC/ESA guidelines on preoperative assessment and perioperative management of patients were published to improve patient safety in non-cardiac surgery. The increase in the adherence to clinical guidelines promotes the improving of the healthcare quality and safety improvement.Aim. To study physicians' level of adherence to ESC/ESA clinical guidelines for preoperative assessment and perioperative management of patients.Material and methods. A retrospective observational study included 102 patients admitted to Moscow general hospital from 01.03.2019 to 30.06.2018 for elective surgery. All of them underwent preoperative examination in outpatient department of the hospital and had at least one concomitant disease requiring drug therapy. The medical records data on the preoperative examination and perioperative treatment with beta-blockers, HMG CoA reductase inhibitors and angiotensin-converting-enzyme (ACE) inhibitors/ angiotensin receptor blockers (ARBs) were analyzed for compliance with the ESC/ESA guidelines.Results. A standardized cardiac risks assessment was not documented in the results of preoperative examination. Electrocardiography (ECG), echocardiography and non-invasive stress tests were performed according to clinical guidelines in 100%, 77.8% and 25% of cases, respectively. Unnecessary ECG and echocardiography were prescribed in 50.5% and 72% of cases, respectively. Appropriate correction of ACE inhibitors/ARBs therapy was performed in 66.7% patients with congestive heart failure and only in 2.7% with arterial hypertension. In 19 patients with ischemic cardiac disease, 13 (84.2%) patients received HMG CoA reductase inhibitors and 16 (68.4%) ones received beta-blockers during hospitalization. Inappropriate omission of statins, beta-blockers and ACE inhibitors (ARBs) during hospitalization was registered in 22.2%, 11% and 4.9% patients, respectively.Conclusion. The number of inappropriate ECGs and echocardiographies, as well as incorrect treatment with beta-blockers, HMG CoA reductase inhibitors and ACE inhibitors (ARBs) in perioperative period evidence that the adherence of physicians to the clinical guidelines on preoperative assessment and perioperative management of patients remains low.It is reasonably to develop risk-based interdisciplinary protocols for preoperative examination, algorithms for interdisciplinary communication and interaction between specialists and the healthcare levels, as well as physicians' education for better adherence to clinical guidelines.https://www.rpcardio.online/jour/article/view/2353preoperative assessmentcardiovascular risknon-cardiac surgeryadherence to clinical guidelinespatient safety |
| spellingShingle | M. D. Nigmatkulova E. B. Kleymenova L. P. Yashina V. A. Otdelenov S. A. Payushchik O. D. Konova D. A. Sychev Adherence to Clinical Quidelines on Preoperative Assessment and Correction of Cardiovascular Risk in Non-cardiac Surgery Рациональная фармакотерапия в кардиологии preoperative assessment cardiovascular risk non-cardiac surgery adherence to clinical guidelines patient safety |
| title | Adherence to Clinical Quidelines on Preoperative Assessment and Correction of Cardiovascular Risk in Non-cardiac Surgery |
| title_full | Adherence to Clinical Quidelines on Preoperative Assessment and Correction of Cardiovascular Risk in Non-cardiac Surgery |
| title_fullStr | Adherence to Clinical Quidelines on Preoperative Assessment and Correction of Cardiovascular Risk in Non-cardiac Surgery |
| title_full_unstemmed | Adherence to Clinical Quidelines on Preoperative Assessment and Correction of Cardiovascular Risk in Non-cardiac Surgery |
| title_short | Adherence to Clinical Quidelines on Preoperative Assessment and Correction of Cardiovascular Risk in Non-cardiac Surgery |
| title_sort | adherence to clinical quidelines on preoperative assessment and correction of cardiovascular risk in non cardiac surgery |
| topic | preoperative assessment cardiovascular risk non-cardiac surgery adherence to clinical guidelines patient safety |
| url | https://www.rpcardio.online/jour/article/view/2353 |
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