The primary cause of preventable delays/postponements for procedures is a problematic cardiovascular evaluation. Close attention to evaluation of patients with cardiac risk factors is essential.
How to obtain Heart And Vascular Care (HVC) Services
Clinical CV risk factors include:
- History of heart disease
- History of current or prior heart failure
- History of cerebrovascular disease
- Diabetes mellitus
- Renal insufficiency
CV Screening Tools
- NSQIP Risk Calculator
- RCRI Risk Calculator - Accurate Activity Tolerance is key risk information. We encourage use of the national "Duke Activity Status Index". An easy DASI online calculator can be accessed at: www.iheartmyheart.com
- Preoperative Score to Predict Postoperative Mortality (POSPOM) Anesthesiology 2016; 124:570-9
- Key CV Evaluation Reference: 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation. 2014 Dec 9;130(24):e278-333. doi: 10.1161/CIR.0000000000000106
ACC/AHA: Noninvasive Stress Testing Before Non-Cardiac Surgery
Increasing myocardial oxygen demand (by pacing or intravenous dobutamine) and inducing hyperemic responses by pharmacologic vasodilators (e.g., intravenous dipyridamole or adenosine [Adenocard]) are the two main methods for preoperative assessment of non-cardiac surgery patients who cannot exercise or who have low activity tolerance/capability (< 4 METS).
General Cardiac Evaluation Recommendations
- If you have questions about cardiac care of patients who have been evaluated in UWH system, please contact the cardiologist, Primary Care Physician, or APP who was involved in the most recent care visit. Otherwise, set up a formal consult visit.
- Patients with active unstable cardiac conditions (e.g., unstable coronary syndrome, decompensated heart failure, significant arrhythmia, severe valvular disease) who are planning to undergo noncardiac surgery should be evaluated and treated using ACC/AHA guidelines
- Noninvasive stress testing can be considered in patients undergoing intermediate-risk noncardiac surgery who have poor functional capacity and at least one clinical risk factor (above)
- Noninvasive testing is not useful in patients undergoing intermediate-risk noncardiac surgery who do not have clinical risk factors
- Noninvasive testing is not useful in stable patients undergoing low-risk noncardiac surgery