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Adherence to Clinical Quidelines on Preoperative Assessment and Correction of Cardiovascular Risk in Non-cardiac Surgery

https://doi.org/10.20996/1819-6446-2020-12-11

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Abstract

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.

About the Authors

M. D. Nigmatkulova
General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education
Russian Federation

Maria D. Nigmatkulova - MD, Postgraduate Student, Chair of Clinical Pharmacology and Therapy, Russian Medical Academy of Continuing Professional Education; Clinical Pharmacologist, General Medical Center of the Bank of Russia.
Sevastopolsky prospect 66, Moscow, 117593; Barrikadnaya ul. 2/1, Moscow, 123995.



E. B. Kleymenova
General 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 Sciences
Russian Federation

Elena B. Kleymenova - MD, PhD, Head of The Department of Healthcare Quality Management, General Medical Center of the Bank of Russia; Leading Researcher, Federal Research Center “Computer Science and Control” of the Russian Academy of Sciences; Professor, Chair of Clinical Pharmacology and Therapy, Russian Medical Academy of Continuing Professional Education.
Sevastopolsky prospect 66, Moscow, 117593; Barrikadnaya ul. 2/1, Moscow, 123995; Vavilova ul. 44-2, Moscow, 119333.



L. P. Yashina
General 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 Sciences
Russian Federation

Lubov P. Yashina - PhD (biology), Consultant, Department of Healthcare quality management; Senior Researcher, Federal Research Center “Computer Science and Control” of the Russian Academy of Sciences
Sevastopolsky prospect 66, Moscow, 117593; Vavilova ul. 44-2, Moscow, 119333.



V. A. Otdelenov
General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education
Russian Federation

Vitaly A. Otdelenov - MD, PhD, Associate Professor, Chair of Clinical Pharmacology and Therapy, Russian Medical Academy of Continuing Professional Education; Clinical pharmacologist, General Medical Center of the Bank of Russia.
Sevastopolsky prospect 66, Moscow, 117593; Barrikadnaya ul. 2/1, Moscow, 123995.



S. A. Payushchik
General Medical Center of the Bank of Russia
Russian Federation

Svetlana A. Payushchik - MD, PhD, Deputy Head of the Department of Healthcare Quality Management, General Medical Center of the Bank of Russia
Sevastopolsky prospect 66, Moscow, 117593.



O. D. Konova
General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education
Russian Federation

Olga D. Konova - Analyst, Research Coordination Department, Russian Medical Academy of Continuing Professional Education; Physician of the Department of Healthcare Quality Management, General Medical Center of the Bank of Russia.
Sevastopolsky prospect 66, Moscow, 117593; Barrikadnaya ul. 2/1, Moscow, 123995.



D. A. Sychev
Russian Medical Academy of Continuing Professional Education
Russian Federation

Dmitry A. Sychev - MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Head of The Chair of Clinical Pharmacology and Therapy, Rector of the Russian Medical Academy of Continuing Professional Education.
Barrikadnaya ul. 2/1, Moscow, 123995.



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For citation:


Nigmatkulova M.D., Kleymenova E.B., Yashina L.P., Otdelenov V.A., Payushchik S.A., Konova O.D., Sychev D.A. Adherence to Clinical Quidelines on Preoperative Assessment and Correction of Cardiovascular Risk in Non-cardiac Surgery. Rational Pharmacotherapy in Cardiology. 2020;16(6):881-887. (In Russ.) https://doi.org/10.20996/1819-6446-2020-12-11

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)