STAT Cardiac Clearance

OB/GYN News, Sept 15, 2003 by Thomas G. McLeod, Jon O. Ebbert

Overview: STAT Cardiac Clearance is a Palm OS handheld computer application that helps health care providers assess perioperative cardiac risk for patients undergoing noncardiac surgery. Those responsible for preoperative assessment and clearance will appreciate the dear, algorithmic approach of this product.

Background: Decision support tools represent yet another category of medical software available for handheld computers. Fundamentally, decision support tools facilitate medical decision making by summarizing the best available evidence into a user-friendly format that may be easily accessed and implemented in the course of a clinical encounter. Scoring indices and stepwise algorithms are common examples of these decisional constructs. From the Glasgow Coma Scale to the Gaff model for breast cancer risk assessment, many decision support tools have found their way into the handheld arena.

Guidelines for perioperative cardiac risk assessment are among those that have been adapted to handheld platforms. As the population ages, the prevalence of subclinical or overt coronary heart disease increases. Though these conditions may remain adequately controlled under circumstances of daffy activity, physiologic stresses associated with anesthesia, surgery; and the postoperative state may precipitate clinical decompensation. Careful preoperate assessment with a decision support tool may help to identify patients at higher risk for cardiac morbidity who may benefit from preoperative medication alterations or angiographic interventions or require postponement of elective procedures.

Description: STAT Cardiac Clearance is based on risk assessment guidelines previously released by the American College of Cardiology/American Heart Association (ACC/AHA) and the American College of Physicians (ACP). The handheld program was developed by Dr. Andre S. Chen, a family physician in Austin, Tex., and initially released in 2001. It is available only for the Palm OS platform and may be downloaded directly from the developer's Web site (www.statcoder.com).

From the opening screen, the user may select either the ACC/AHA or the ACP risk assessment tool. Navigation through each guideline involves tap selections and check-boxes and is intuitive. The ACC/AHA guideline was originally released in 1996 and updated in 2002. It incorporates observational data and expert opinion into a stepwise algorithmic approach to perioperative cardiac risk assessment. Several factors are used to determine risk and recommendations for management. These include urgency of the proposed surgery, clinical predictors of risk (recent unstable angina, prior MI, diabetes), functional capacity, and risk associated with the surgical procedure. Highrisk patients identified by this algorithm may benefit from preoperative noninvasive cardiac testing and intervention.

The ACP guideline was originally published in 1997. It is based on the Detsky modified risk index and results of noninvasive testing such as dipyridamole thallium imaging or dobutamine stress echocardiography. Detsky's index incorporates history, examination, and electrocardiographic features of the original Goldman criteria (age over 70 years, MI within 6 months, severe aortic stenosis, etc.) but adjusts the scoring further based on anginal characteristics and presence/absence of recent pulmonary edema. In the ACC/AHA guideline, these factors are used to determine perioperative cardiac risk and whether or not additional preoperative testing is indicated.

Final Notes: STAT Cardiac Clearance is an easy-to-use handheld application for assessment of perioperative cardiac risk for patients undergoing noncardiac surgery. The program includes both ACC/AHA and ACP risk assessment guidelines. A streamlined and intuitive interface facilitates convenient on-the-fly use, and decision points are clearly indicated.

Contact/Download Information:

Title: STAT Cardiac Clearance

Developer: Dr. Andre Chen

Web site: www.statcoder.com

Platform: Palm OS

Memory: Palm ~ 95KB

Cost: Free from developer Web site

DR. THOMAS G. McLeod and DR. JON O. EBBERT are with the division of community internal medicine at the Mayo Clinic, Rochester, Minn. Their reviews are independent evaluations, and they receive no compensation from and do not consult with the manufacturers of the products evaluated in this column.