DALLAS -- Preoperative evaluation of patients with heart disease should focus on determining current medical status, not providing clearance for surgery, according to an update of guidelines from the American Heart Association and the American College of Cardiology.
DALLAS, Oct. 1 -- Preoperative evaluation of patients with heart disease should focus on determining current medical status, not providing clearance for surgery, according to an update of guidelines from the American Heart Association and American College of Cardiology.
In the preoperative evaluation before noncardiac surgery, "intervention is rarely necessary to simply lower the risk of surgery unless such intervention is indicated irrespective of the preoperative context," members of the AHA/ACC writing committee asserted online ahead of the Oct. 23 issues of Circulation and the Journal of the American College of Cardiology.
The authors further stated that "no test should be performed unless it is likely to influence patient treatment." The evaluation should prepare physicians to "make recommendations concerning the evaluation, management, and risk of cardiac problems over the entire perioperative period."
The end result of the preoperative evaluation, the authors said, should be to develop a clinical risk profile that peri- and postoperative caregivers can use to make treatment decisions.
In an update of their 2002 joint guidelines, the two organizations emphasized that many patients with heart disease can safely undergo noncardiac surgery without first having an intervention-such as coronary angioplasty or bypass surgery-to treat the heart disease.
"Several trials now show that in people without symptomatic heart disease, fixing the heart first doesn't make much of a difference in how well they do in surgery," said Lee A. Fleisher, M.D., of the University of Pennsylvania in Philadelphia, chair of the guideline writing committee.
Preoperative evaluation and treatment should be limited to patients who have "active" cardiac conditions, such as unstable angina, decompensated heart failure, significant arrhythmias, or severe heart valve disease.
Recommendations in the update also include: