Alexandra Stroda, Tanja Sulot, Sebastian Roth, René M'Pembele, Eckhard Mauermann, Daniela Ionescu, Wojciech Szczeklik, Stefan De Hert, Miodrag Filipovic, Beatrice Beck Schimmer, Savino Spadaro, Purificación Matute, Sanem Cakar Turhan, Judith van Waes, Filipa Lagarto, Kassiani Theodoraki, Anil Gupta, Hans-Jörg Gillmann, Luca Guzzetti, Katarzyna Kotfis, Jan Larmann, Dan Corneci, Simon J Howell, Giovanna Lurati Buse
{"title":"影响遵守术前心脏检查建议的因素：一项队列研究。","authors":"Alexandra Stroda, Tanja Sulot, Sebastian Roth, René M'Pembele, Eckhard Mauermann, Daniela Ionescu, Wojciech Szczeklik, Stefan De Hert, Miodrag Filipovic, Beatrice Beck Schimmer, Savino Spadaro, Purificación Matute, Sanem Cakar Turhan, Judith van Waes, Filipa Lagarto, Kassiani Theodoraki, Anil Gupta, Hans-Jörg Gillmann, Luca Guzzetti, Katarzyna Kotfis, Jan Larmann, Dan Corneci, Simon J Howell, Giovanna Lurati Buse","doi":"10.1097/EJA.0000000000002039","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Design: </strong>Secondary analysis of a multicentre, international, prospective cohort study (MET-REPAIR).</p><p><strong>Setting: </strong>Twenty-five European centres of all levels of care that enrolled patients between 2017 and 2020.</p><p><strong>Patients: </strong>With elevated cardiovascular risk undergoing in-hospital elective, noncardiac surgery.</p><p><strong>Main outcome measures: </strong>(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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Trial registration: </strong>NCT03016936.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Factors affecting adherence to recommendations on pre-operative cardiac testing: A cohort study.\",\"authors\":\"Alexandra Stroda, Tanja Sulot, Sebastian Roth, René M'Pembele, Eckhard Mauermann, Daniela Ionescu, Wojciech Szczeklik, Stefan De Hert, Miodrag Filipovic, Beatrice Beck Schimmer, Savino Spadaro, Purificación Matute, Sanem Cakar Turhan, Judith van Waes, Filipa Lagarto, Kassiani Theodoraki, Anil Gupta, Hans-Jörg Gillmann, Luca Guzzetti, Katarzyna Kotfis, Jan Larmann, Dan Corneci, Simon J Howell, Giovanna Lurati Buse\",\"doi\":\"10.1097/EJA.0000000000002039\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Design: </strong>Secondary analysis of a multicentre, international, prospective cohort study (MET-REPAIR).</p><p><strong>Setting: </strong>Twenty-five European centres of all levels of care that enrolled patients between 2017 and 2020.</p><p><strong>Patients: </strong>With elevated cardiovascular risk undergoing in-hospital elective, noncardiac surgery.</p><p><strong>Main outcome measures: </strong>(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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Trial registration: </strong>NCT03016936.</p>\",\"PeriodicalId\":11920,\"journal\":{\"name\":\"European Journal of Anaesthesiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.2000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Anaesthesiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/EJA.0000000000002039\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/10 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Anaesthesiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/EJA.0000000000002039","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/10 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Factors affecting adherence to recommendations on pre-operative cardiac testing: A cohort study.
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.
期刊介绍：
The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).
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