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Preoperative cardiac risk assessment
1Section of Cardiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA. shollenb@rpslmc.edu
Insights
Preoperative cardiac evaluation assesses patient risk for perioperative cardiac events. Stratifying patients and tailoring tests to surgery type optimizes management and informs treatment decisions.
Area of Science:
- Cardiology
- Anesthesiology
- Perioperative Medicine
Background:
- Preoperative cardiac evaluation is crucial for assessing patient medical status before non-cardiac surgery.
- It aims to identify and manage risks of cardiac complications during the perioperative period.
- A clear clinical risk profile aids treatment decisions for patients, physicians, and surgical teams.
Purpose of the Study:
- To outline a structured approach to preoperative cardiac evaluation.
- To guide the appropriate use of cardiac testing and intervention based on patient risk and surgical factors.
- To emphasize the importance of considering both short- and long-term cardiac risk assessment.
Main Methods:
- Stratification of patients into low-, medium-, and high-risk categories based on clinical grounds.
- Consideration of non-cardiac surgery type and urgency in determining testing strategies.
- Limiting invasive and noninvasive testing to situations where results will directly impact patient management.
Main Results:
- A risk-stratified approach, combined with surgical context, enables reasonable preoperative testing.
- Indications for cardiac testing and treatment generally align with nonoperative settings.
- Testing choices and timing are influenced by patient-specific, surgical, and clinical factors.
Conclusions:
- Preoperative cardiac evaluation provides a vital opportunity for assessing cardiac risk.
- Cardiac intervention is seldom required solely to reduce surgical risk.
- Further research is needed to establish the optimal efficacy and cost-effectiveness of preoperative cardiac testing.
Abstract:
Preoperative cardiac evaluation is aimed at evaluating the patient's current medical status, making recommendations concerning the risk of cardiac problems in the perioperative period, and providing a clinical risk profile that the patient, primary physician, consultants, anesthesiologist, and surgeon can use in making treatment decisions. Patients can be stratified on clinical grounds into low-, medium-, and high-risk categories. Use of these categories, along with consideration of the type and urgency of noncardiac surgery, allows for a reasonable approach to preoperative testing. In general, indications for cardiac testing and treatment are similar to the nonoperative setting, but their choice and timing is dependent on factors specific to the patient, the type of surgery, and the clinical situation. Use of invasive and noninvasive testing should be limited to situations in which the results of the tests will clearly affect patient management. Further research is necessary to define the most appropriate role of such testing, both in terms of efficacy and of cost-effectiveness. Cardiac intervention is rarely necessary to lower the risk of surgery, but noncardiac surgery often represents the first opportunity for a patient to receive an appropriate assessment of short- and long-term cardiac risk, and this should be taken into consideration in planning perioperative evaluation.