Preoperative evaluation for major noncardiac surgery: focusing on heart failure

The number of patients undergoing major noncardiac surgery has steadily increased over the last decade. Cardiovascular complications are important and often feared by patients, surgeons, and anesthesiologists. Although preoperative risk assessment has improved since Goldman and colleagues published their landmark article that introduced the Multifactorial Index of Cardiac Risk 25 years ago, it continues to require modification, especially with the increasing prevalence of heart failure and the increase in procedures performed in the elderly. This review will summarize preoperative assessment and perioperative management with an emphasis on heart failure.