Cardiac assessment prior to non-cardiac surgery

Area of Science:

• Cardiology
• Anesthesiology
• Perioperative Medicine

Background:

• Older patients with comorbidities undergoing non-cardiac surgery present challenges in preoperative cardiac assessment.
• Current preoperative cardiac assessment practices are often unsystematic and vary widely.
• There is a need to evaluate if high-risk patients receive adequate assessment and low-risk patients are not over-investigated.

Purpose of the Study:

• To compare the utilization of cardiac investigations in patients stratified by preoperative cardiac risk before non-cardiac surgery.
• To identify disparities in cardiac assessment between high-risk and low-risk surgical patients.

Main Methods:

• A representative sample of patients undergoing elective non-cardiac surgery was analyzed.
• Preoperative cardiac risk was determined using the Revised Cardiac Risk Index.
• Cardiac assessment patterns were examined in relation to patient risk stratification.

Main Results:

• Out of 671 patients, 12% were classified as high-risk and 88% as low-risk.
• Nearly 45% of high-risk patients and 14% of low-risk patients underwent investigations for coronary ischemia.
• High-risk patients with coronary disease were undertreated with beta-blockers (46%), aspirin (49%), and statins (77%).

Conclusions:

• Preoperative cardiac investigation patterns are inconsistent across surgical subspecialties.
• Low-risk patients tend to be over-investigated, while high-risk patients are under-investigated.
• A systematic approach to cardiac risk assessment could enhance clinical outcomes, reduce healthcare costs, and improve efficiency.