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ACC/AHA
Guideline Update for Perioperative Cardiovascular Evaluation
for Noncardiac Surgery
A
Report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines
(Committee to Update the 1996 Guidelines on Perioperative
Cardiovascular Evaluation for Noncardiac Surgery)
Preamble
Clearly
it is important that the medical profession play a significant
role in critically evaluating the use of diagnostic
procedures and therapies in the management or prevention
of disease states. Rigorous and expert analysis of the
available data documenting relative benefits and risks
of those procedures and therapies can produce helpful
guidelines that improve the effectiveness of care, optimize
patient outcomes, and impact the overall cost of care
favorably by focusing resources on the most effective
strategies.
The
American College of Cardiology (ACC) and the American
Heart Association (AHA) have produced such guidelines
in the area of cardiovascular disease jointly since
1980. This report was directed by the ACC/AHA Task Force
on Practice Guidelines, which has as its charge to develop
and revise practice guidelines for important cardiovascular
diseases and procedures. Experts in a given field are
selected from both organizations to examine subject-specific
data and write guidelines. Additional representatives
from other medical practitioner and specialty groups
are included in the writing process when appropriate.
Each writing group is specifically charged to perform
a formal literature review, weigh the strength of evidence
for or against a particular treatment or procedure,
and include estimates of expected health outcomes where
data exist. Patient-specific modifiers, comorbidities,
and issues of patient preference that might influence
the choice of particular tests or therapies are considered
along with frequency of follow-up and cost-effectiveness.
These
practice guidelines are intended to assist physicians
in clinical decision making by describing a range of
generally acceptable approaches for the diagnosis, management,
or prevention of specific diseases or conditions. These
guidelines attempt to define practices that meet the
needs of most patients in most circumstances. The ultimate
judgment regarding care of a particular patient must
be made by the physician and patient in light of all
of the circumstances presented by that patient.
The
1996 Committee to Develop Guidelines
on Perioperative Cardiovascular Evaluation for Noncardiac
Surgery was chaired by Kim A. Eagle, MD, and included
the following members: Bruce H. Brundage, MD; Bernard
R. Chaitman, MD; Gordon A. Ewy, MD; Lee A. Fleisher,
MD; Norman R. Hertzer, MD; Jeffrey A. Leppo, MD; Thomas
Ryan, MD; Robert C. Schlant, MD; William H. Spencer
III, MD; John A. Spittell, Jr, MD; and Richard D. Twiss,
MD. The document update used the 1996 work as its basis.
The Committee to Update the 1996 Guidelines on Perioperative
Cardiovascular Evaluation for Noncardiac Surgery was
chaired by Kim A. Eagle, MD, and included the following
members: Peter B. Berger, MD; Hugh Calkins, MD; Bernard
R. Chaitman, MD; Gordon A. Ewy, MD; Kirsten E. Fleischmann,
MD; Lee A. Fleisher, MD; James B. Froehlich, MD; Richard
J. Gusberg, MD; Jeffrey A. Leppo, MD; Thomas J. Ryan,
MD; Robert C. Schlant, MD; William L. Winters, Jr.,
MD.
The
ACC/AHA Task Force on Practice Guidelines makes every
effort to avoid any actual or potential conflicts of
interest that might arise as a result of an outside
relationship or personal interest of a member of the
writing panel. Specifically, all members of the writing
panel are asked to provide disclosure statements of
all such relationships that might be perceived as real
of potential conflicts of interest. These statements
are reviewed by the parent task force, reported orally
to all members of the writing panel at the first meeting,
and updated as changes occur. It was approved by the
ACC Board of Trustees and the AHA Science Advisory and
Coordinating Committee and is being published simultaneously
in the Journal of the American College of Cardiology
and Circulation on February 6, 2002 and March
5, 2002, respectively.
This
document was reviewed by two outside reviewers from
the AHA and two outside reviewers of the ACC, as well
as one reviewer of the ACC/AHA Task Force on Practice
Guidelines. The document will be reviewed annually after
the date of publication and considered current unless
the Task Force publishes another update or full revision
or withdraws it from publication.
Raymond
J. Gibbons, MD, FACC
Chair, ACC/AHA Task Force on Practice Guidelines
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