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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)
This
guideline has been updated based on an extensive review
of the literature since publication in the Journal
of the American College of Cardiology (J Am Coll
Cardiol 1996;27:910-48). This updated version has been
reviewed and approved by the American College of Cardiology
and the American Heart Association. The guidelines are
available on the Web sites of both the American College
of Cardiology (www.acc.org ) and the American Heart
Association (www.americanheart.org ). Deleted text is
indicated by strikeout, and revised text is presented
in red. A clean version of the document, with changes
fully incorporated, is available for download and print.
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
ACC/AHA classifications I, II, and III are used in this
report to summarize indications for a particular therapy
or treatment as follows:
Class
I: Conditions for which there is evidence for and/or
general agreement that a procedure be performed or a
treatment is of benefit.
Class
II: Conditions for which there is a divergence of evidence
and/or opinion about the treatment.
Class
III: Conditions for which there is evidence and/or general
agreement that the procedure/treatment is not necessary.
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 CommitteeACC/Steering
Committee and is being published simultaneously
in the Journal of the American College of Cardiology
and Circulation in March 1996
February 6, 2002 and March 5, 2002, respectively.
The document was also endorsed by the Society for
Cardiovascular Anesthesiologists, the Society for Vascular
Surgery, and the North American Chapter of the International
Society for Cardiovascular Surgery.
This
document was reviewed by three outside reviewers nominated
by the ACC and by three outside reviewers nominated
by the AHA, as well as reviewers nominated by the American
Academy of Family Physicians, the Society of Vascular
Surgery, and the Society for Cardiovascular Anesthesiologists.
The document will be reviewed 2 years after the date
of publication and yearly thereafter and considered
current unless the Task Force publishes a revision or
withdrawal. 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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