Perioperative cardiac evaluation of simulated patients by practicing anesthesiologists is not consistent with 2007 ACC/AHA guidelines

Study ObjectiveTo determine if practicing anesthesiologists recommend preoperative evaluations consistent with the 2007 ACC/AHA guidelines on perioperative care.DesignSurvey instrument.SettingAcademic medical center.SubjectsASA membership.MeasurementsIn this Web-based survey, participants were presented with 6 clinical scenarios characterized by surgical procedure and the patient's clinical condition (ie, clinical risk factors and functional capacity). Scenarios and possible recommendations were presented randomly. Participants were asked to select the recommendation they considered to be most consistent with the Guidelines. The percentage of participants selecting the recommendation most consistent with the 2007 Guidelines was recorded.Main ResultsOf the 22,504 actively practicing members of the ASA who were sent a survey, 1,595 actively practicing self-selected anesthesiologists responded. For one of 6 scenarios, patients with an active cardiac condition, the upper 95% confidence bound for the percent selecting a recommendation consistent with the Guidelines was 82%. For the remaining 5 scenarios, the upper 95% confidence bound for the percent of anesthesiologists with an appropriate recommendation did not exceed 40%. With the exception of the scenario describing a patient with an active cardiac condition, respondents were more likely to provide recommendations consistent with the Guidelines if they had been in practice less than 5 years or worked in a teaching environment.ConclusionWhen evaluating simulated patients, practicing anesthesiologists who are ASA members did not recommend preoperative evaluations that were consistent with the 2007 ACC/AHA Guidelines.