Anticipated Rates and Costs of Guideline-Concordant Preoperative Stress Testing

Anesthesia and Analgesia
Matthew A PappasMichael B Rothberg

Abstract

Current guidelines recommend that patients have preoperative assessment of cardiac risk and functional status, and that patients at "elevated" cardiac risk with poor or unknown functional status be referred for preoperative stress testing. Little is known about current rates of testing or resultant medical costs. We set out to estimate the expected rates of preoperative stress testing and resultant costs if physicians in the United States were to follow current guidelines and to investigate differences that would arise from 2 risk prediction methods included in current guidelines. We applied 2 risk prediction tools (Revised Cardiac Risk Index and Myocardial Infarction or Cardiac Arrest) included in current American College of Cardiology/American Heart Association guidelines to a multicenter prospective registry of patients undergoing surgery in the United States in 2009. We then calculated expected rates of preoperative cardiac stress testing if physicians were to follow American College of Cardiology/American Heart Association guidelines, expected nationwide direct medical expenditures that would result (in 2017 US dollars), and agreement beyond chance between the 2 risk prediction tools. Current guidelines recommend considera...Continue Reading

References

Dec 31, 2004·The New England Journal of Medicine·Edward O McFallsWilliam G Henderson
Jan 30, 2010·BMJ : British Medical Journal·Duminda N WijeysunderaAndreas Laupacis
Apr 20, 2011·Annals of Internal Medicine·P J DevereauxUNKNOWN POISE (PeriOperative ISchemic Evaluation) Investigators
May 15, 2013·Circulation·Judith A R van WaesUNKNOWN Cardiac Health After Surgery (CHASE) Investigators
May 14, 2014·JAMA Internal Medicine·Aaron L SchwartzJ Michael McWilliams
Jun 9, 2015·JAMA Internal Medicine·Alana E SigmundJoseph A Ladapo
Dec 3, 2015·The New England Journal of Medicine·P J Devereaux, Daniel I Sessler
May 24, 2016·Annals of Internal Medicine·Daniel B MarkUNKNOWN PROMISE Investigators
Nov 16, 2016·JAMA Cardiology·Vinay KiniPeter W Groeneveld

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Citations

Jan 17, 2019·Anesthesia and Analgesia·Lee A FleisherDuminda N Wijeysundera

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