Perioperative Cardiac Risk Management

SUMMARY
Perioperative cardiac complications are the most widely feared medical issues for the anesthesiologist, surgeon, and medical consultant as they approach a patient in the perioperative period. Only recently have management strategies been addressed in high-quality studies. The following module explains the roles of medical and interventional treatments in lowering perioperative cardiac event rates. This module also discusses the typical presentation of coronary syndromes postoperatively and the management of antiplatelet and cardiac medications.
 
GOAL
To provide hospitalists with current management strategies to reduce the risk of perioperative cardiac events.
 
TARGET AUDIENCE
This activity is designed for hospitalists. 
 
LEARNING OBJECTIVES
After participating in this module, the participant will demonstrate the ability to:
 
  1. Analyze the evidence for beta-blocker therapy in the management of patients at elevated perioperative risk for cardiac events.
  2. Assess the role for statins in perioperative cardiac risk reduction.
  3. Discuss the importance of continuing cardiac medications in the perioperative setting and the role of clonidine, aspirin, and nitrates in reducing perioperative cardiac risk.
  4. Evaluate the role for coronary interventions in preoperative patients with documented ischemia on noninvasive cardiac testing.
  5. Discuss the perioperative management of antiplatelet therapy for patients with cardiac stents.
  6. Elucidate the typical presentation of postoperative myocardial infarctions and realize the utility of screening measures.
CME INFORMATION
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of University of Virginia School of Medicine, ASiM, and the Society of Hospital Medicine. The University of Virginia School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
 
Credit Designation Statement
The University of Virginia School of Medicine designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
 
Release date: June 23, 2015                Expiration date: June 23, 2018
 
FACULTY AND FACULTY DISCLOSURES
Full Disclosure Policy Affecting CME Activities:
The University of Virginia School of Medicine, as an ACCME accredited provider, endorses and strives to comply with the Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, Commonwealth of Virginia statutes, University of Virginia policies and procedures, and associated federal and private regulations and guidelines on the need for disclosure and monitoring of proprietary and financial interests that may affect the scientific integrity and balance of content delivered in continuing medical education activities under our auspices.
 
The University of Virginia School of Medicine requires that all CME activities accredited through this institution be developed independently and be scientifically rigorous, balanced and objective in the presentation/discussion of its content, theories and practices.
 
All faculty presenters participating in an accredited CME activity are expected to disclose relevant financial relationships with commercial entities occurring within the past 12 months (such as grants or research support, employee, consultant, stock holder, member of speakers bureau, etc.). The University of Virginia School of Medicine will employ appropriate mechanisms to resolve potential conflicts of interest to maintain the standards of fair and balanced education to the participant. Questions about specific strategies can be directed to the Office of Continuing Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia.
 
The faculty and staff of the University of Virginia Office of Continuing Medical Education have no financial affiliations to disclose.
 
The following relationships have been reported for this activity:
 
Leonard Feldman, MD, FACP, SFHM (Chair)
Associate Professor of Medicine
Johns Hopkins University School of Medicine 
Med-Peds Urban Health Residency Program Director
Associate Program Director, Osler Medical Residency
Director, Comprehensive General Medicine Consult Service
Editor, Consultative, and Perioperative Medicine Essentials for Hospitalists
Baltimore, Maryland
Dr. Feldman reports having no significant financial or advisory relationships with corporate organizations related to this activity. 
 
Steven L. Cohn, MD, FACP, SFHM
Medical Director – UHealth Preoperative Assessment Center
Director–UMH Medical Consultation Service
Professor of Clinical Medicine
University of Miami – Miller School of Medicine
Miami, Florida
Dr. Cohn reports having minor stock holdings in AstraZeneca, GlaxoSmithKline, Merck & Co, Inc, and Pfizer Inc; and serving on the Advisory Boards for Janssen and Bristol Myers Squibb. 
 
Bartho Caponi, MD, FACP, FHM (Peer Reviewer)
Clinical Associate Professor
Division of Hospital Medicine
University of Wisconsin Hospital and Clinics
Madison, Wisconsin
Dr Caponi reports having no significant financial or advisory relationships with corporate organizations related to this activity.
Please note, there is an ongoing inquiry into publications involving Dr Poldermans and his colleagues. The results of this inquiry may affect recommendations regarding perioperative use of β-blockers and statins.
 
Off-Label Product Discussion:
All faculty have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices. 
 
DISCLAIMER
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the University of Virginia School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.
 
Click here to download references for this educational activity.
 
This activity is supported by independent educational grants from Boehringer Ingelheim Pharmaceuticals, Inc, Bristol-Myers Squibb Company, and Pfizer Inc.
Course summary
Available credit: 
  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 Participation (non-CME)
Course opens: 
06/23/2015
Course expires: 
06/23/2018
Member cost:
$0.00
Non-member cost:
$0.00
Parent activity set: 
Rating: 
0

Available Credit

  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 Participation (non-CME)

Accreditation Period

Course opens: 
06/23/2015
Course expires: 
06/23/2018

Price

Member cost:
$0.00
Non-member cost:
$0.00
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