TY - JOUR
T1 - Factors affecting adherence to recommendations on pre-operative cardiac testing
T2 - A cohort study
AU - Stroda, Alexandra
AU - Sulot, Tanja
AU - Roth, Sebastian
AU - M'pembele, René
AU - Mauermann, Eckhard
AU - Ionescu, Daniela
AU - Szczeklik, Wojciech
AU - De Hert, Stefan
AU - Filipovic, Miodrag
AU - Beck Schimmer, Beatrice
AU - Spadaro, Savino
AU - Matute, Purificación
AU - Turhan, Sanem Cakar
AU - Van Waes, Judith
AU - Lagarto, Filipa
AU - Theodoraki, Kassiani
AU - Gupta, Anil
AU - Gillmann, Hans Jörg
AU - Guzzetti, Luca
AU - Kotfis, Katarzyna
AU - Larmann, Jan
AU - Corneci, Dan
AU - Howell, Simon J.
AU - Lurati Buse, Giovanna
N1 - Publisher Copyright:
Copyright © 2024 European Society of Anaesthesiology and Intensive Care.
PY - 2024/9
Y1 - 2024/9
N2 - BACKGROUND Cardiac risk evaluation prior to noncardiac surgery is fundamental to tailor peri-operative management to patient’s estimated risk. Data on the degree of adherence to guidelines in patients at cardiovascular risk in Europe and factors influencing adherence are underexplored. OBJECTIVES The aim of this analysis was to describe the degree of adherence to [2014 European Society of Cardiology (ESC)/European Society of Anaesthesiology (ESA) guidelines] recommendations on rest echocardiography [transthoracic echocardiography (TTE)] and to stress imaging prior to noncardiac surgery in a large European sample and to assess factors potentially affecting adherence. DESIGN Secondary analysis of a multicentre, international, prospective cohort study (MET-REPAIR). SETTING Twenty-five European centres of all levels of care that enrolled patients between 2017 and 2020. PATIENTS With elevated cardiovascular risk undergoing in-hospital elective, noncardiac surgery. MAIN OUTCOME MEASURES (Non)adherence to each pre-operative TTE and stress imaging recommendations classified as guideline-adherent, overuse and underuse. We performed descriptive analysis. To explore the impact of patients’ sex, age, geographical region, and hospital teaching status, we conducted multivariate multinominal regression analysis. RESULTS Out of 15 983 patients, 15 529 were analysed (61% men, mean age 72 ± 8 years). Overuse (conduction in spite of class III) and underuse (nonconduction in spite of class I recommendation) for pre-operative TTE amounted to 16.6% (2542/15 344) and 6.6% (1015/15 344), respectively. Stress imaging overuse and underuse amounted to 1.7% (241/14 202) and 0.4% (52/14 202) respectively. Male sex, some age categories and some geographical regions were significantly associated with TTE overuse. Male sex and some regions were also associated with TTE underuse. Age and regions were associated with overuse of stress imaging. Male sex, age, and some regions were associated with stress imaging underuse. CONCLUSION Adherence to pre-operative stress imaging recommendation was high. In contrast, adherence to TTE recommendations was moderate. Both patients’ and geographical factors affected adherence to joint ESC/ESA guidelines.
AB - BACKGROUND Cardiac risk evaluation prior to noncardiac surgery is fundamental to tailor peri-operative management to patient’s estimated risk. Data on the degree of adherence to guidelines in patients at cardiovascular risk in Europe and factors influencing adherence are underexplored. OBJECTIVES The aim of this analysis was to describe the degree of adherence to [2014 European Society of Cardiology (ESC)/European Society of Anaesthesiology (ESA) guidelines] recommendations on rest echocardiography [transthoracic echocardiography (TTE)] and to stress imaging prior to noncardiac surgery in a large European sample and to assess factors potentially affecting adherence. DESIGN Secondary analysis of a multicentre, international, prospective cohort study (MET-REPAIR). SETTING Twenty-five European centres of all levels of care that enrolled patients between 2017 and 2020. PATIENTS With elevated cardiovascular risk undergoing in-hospital elective, noncardiac surgery. MAIN OUTCOME MEASURES (Non)adherence to each pre-operative TTE and stress imaging recommendations classified as guideline-adherent, overuse and underuse. We performed descriptive analysis. To explore the impact of patients’ sex, age, geographical region, and hospital teaching status, we conducted multivariate multinominal regression analysis. RESULTS Out of 15 983 patients, 15 529 were analysed (61% men, mean age 72 ± 8 years). Overuse (conduction in spite of class III) and underuse (nonconduction in spite of class I recommendation) for pre-operative TTE amounted to 16.6% (2542/15 344) and 6.6% (1015/15 344), respectively. Stress imaging overuse and underuse amounted to 1.7% (241/14 202) and 0.4% (52/14 202) respectively. Male sex, some age categories and some geographical regions were significantly associated with TTE overuse. Male sex and some regions were also associated with TTE underuse. Age and regions were associated with overuse of stress imaging. Male sex, age, and some regions were associated with stress imaging underuse. CONCLUSION Adherence to pre-operative stress imaging recommendation was high. In contrast, adherence to TTE recommendations was moderate. Both patients’ and geographical factors affected adherence to joint ESC/ESA guidelines.
UR - http://www.scopus.com/inward/record.url?scp=85198663624&partnerID=8YFLogxK
U2 - 10.1097/EJA.0000000000002039
DO - 10.1097/EJA.0000000000002039
M3 - Article
C2 - 38988248
AN - SCOPUS:85198663624
SN - 0265-0215
VL - 41
SP - 695
EP - 704
JO - European Journal of Anaesthesiology
JF - European Journal of Anaesthesiology
IS - 9
ER -