Degree Name

Doctor of Nursing Practice

Document Type

Scholarly Project

Date Created


Embargo Date



Leeper, Robert S., Implementation of American College of Cardiology/American Hospital Association Cardiovascular Evaluation Guidelines for Patients having Non-cardiac Surgery. Unpublished Doctor of Nursing Practice Scholarly Project, University of Northern Colorado, (2020).

Anesthesia outcomes in non-cardiac surgery are dependent upon recognition of cardiovascular disease, estimating functional capacity, the status of existing co-morbidities, and degree of end-organ disease. Anesthesia providers in a rural surgery center identified an increase in the number of patients coming to the surgery center with unstable cardiovascular conditions resulting in delayed start-times, postponements, and cancellations. The broader objective for this anesthesia quality improvement project was greater patient access, improved quality of life, and safer delivery of anesthesia service. Anesthesia provider’s cardiovascular evaluation methodology was updated by providing education for anesthesia staff including implementation of recommendations and step-wise algorithm in the current American College of Cardiology/American Heart (Fleisher et al., 2014) guidelines. According to the guidelines anesthesia providers can greatly reduce the number of surgical start-time delays or cancellations due to unstable cardiovascular conditions on the day of surgery. Following evidence-based guideline recommendations and cardiac assessment tools anesthesia providers are able to minimize the probability of major adverse cardiac events. Quality anesthesia care is enhanced by pre-operative identification of active cardiac disease, estimation of functional capacity using the Duke Activity Scale Index, and a cardiac risk calculator the Revised Cardiac Risk Index (Lee et al. 1999). The primary objective for this anesthesia quality improvement project was greater patient access, safer anesthesia delivery, and improved quality of life. Donabedian’s (1990) structure-process-outcome model provided the framework for this clinical practice improvement project.


Keywords: active cardiac disease, major adverse cardiac events, functional capacity, cardiac risk stratification.

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Copyright is held by the author.