Cardiac overscreening hip fracture patients

Area of Science:

• Cardiology
• Geriatric Medicine
• Orthopedic Surgery

Background:

• Hip fracture patients require careful perioperative assessment.
• Adherence to American College of Cardiology (ACC) and American Heart Association (AHA) guidelines is crucial for patient outcomes.
• Current clinical practice for perioperative cardiac assessment in hip fracture patients needs investigation.

Purpose of the Study:

• To prospectively evaluate adherence to ACC/AHA guidelines for perioperative cardiac assessment in hip fracture patients.
• To determine the impact of guideline adherence on patient outcomes.
• To analyze factors influencing preoperative cardiac screening and surgical delay.

Main Methods:

• Prospective cohort study of 166 hip fracture patients over 3 years.
• Analysis of preoperative cardiac screening and ACC/AHA guideline adherence.
• Classification of cardiac risk (low, intermediate, high).
• Secondary outcomes included surgical delay, complications, and mortality at various time points.

Main Results:

• 87% of patients received correct preoperative cardiac screening per ACC/AHA guidelines.
• Overscreening (> 90%) was the primary reason for incorrect screening.
• Cardiac consultation and overscreening significantly predicted increased surgical delay.
• High-risk patients had higher in-hospital mortality compared to low-risk patients.
• Previous cardiac history and surgical delay predicted early mortality; high age and cardiac history predicted late mortality.

Conclusions:

• Adherence to ACC/AHA guidelines for preoperative cardiac screening in hip fracture patients is linked to reduced preoperative resource utilization.
• Overscreening contributes to surgical delays, elevating the risk of perioperative complications and early mortality.
• Optimizing cardiac screening protocols can improve patient outcomes and resource management.