Can doctors in the real world follow the AHA/ACC
guidelines? NO. In a study of this exact question Doctors
at a Veteran Affairs medical preoperative evaluation clinic
from January 1 to April 1, 1998 tried to follow the AHA/ACC
guidelines and ended up with Guideline chaos: conflicting
recommendations for preoperative cardiac assessment (Am J
Cardiol. 2003 Jun 1;91(11):1299-303). Guidelines never agreed
on the need for noninvasive stress testing. There were extreme
differences in recommendations (7%). Even when physicians
really tried to follow the recommendations, they ordered non
invasive stress testing more often (n = 27) than either guideline.
When applied to real patients being evaluated for surgery,
ACC/AHA and ACP guidelines significantly differed in recommendations
for preoperative cardiac testing.
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