Physicians' Academy for Cardiovascular Education

New European and American guidelines on management of CV risk in non-cardiac surgery

Aug. 5, 2014 - news

 
Both the European Society of Cardiology (ESC), together with the European Society of Anaesthesiology (ESA) and the American College of Cardiology (ACC) and the American Heart Association (AHA) have issued new versions of the guidelines on the peri-operative cardiovascular evaluation and management, in patients undergoing non-cardiac surgery, in whom heart disease is a potential source of complications.
 
The European and American Guideline Committees independently reviewed newly available evidence on the topic and the arisen controversy about the legitimacy of previously published data of pivotal trials. Specifically, the evidence about beta-blocker therapy used in the peri-operative period was critically considered. Treatment recommendations were established and then shared between the two writing committees, and possible discrepancies were discussed.
The revised Clinical Practice Guidelines contain objective review of old and new evidence on the use of beta blockers in patients who have taken them chronically, considerations regarding selection of patients who are potential candidates to receive beta blockers preoperatively, and guidance regarding how to use this drug class peri-operatively, in carefully selected high-risk patients. Routine use of beta-blockers in patients who undergo non-cardiac surgery is no longer recommended by any of the guidelines .
 
Although differences in the outline of the two documents exist, they both discuss peri-operative therapy options to reduce the risk of cardiac complications, including coronary revascularisation before non-cardiac surgery, beta blockers, statins, Alpha-2 agonists, antiplatelet agents and ACE inhibitors. Anaesthetic considerations are described, and recommendations on intra-operative management are given. The ESC guideline furthermore discusses specific types of surgery, as well as specific pre-existing diseases that need to be considered.
 
The recommendations in the ACC/AHA and ESC/ESA guidelines are now fundamentally aligned, to facilitate worldwide optimal standardised care. Differences between the recommendations in the respective guidelines are the result of international practice differences.
 

Sources

- 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management
The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA)
Practice Guideline August 2014
- 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.  Fleisher LA, Fleischmann KE, Auerbach AD, et al., J Am Coll Cardiol. 2014; doi: 10.1016/j.jacc.2014.07.945
- Clinical Practice Guidelines on Perioperative Cardiovascular Evaluation: Collaborative Efforts Among the ACC, AHA, and ESC. Anderson JL, Antman EM, Harold JG et al., J Am Coll Cardiol. 2014. doi:10.1016/j.jacc.2014.07.938