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This activity reviews the presurgical cardiac risk assessment and highlights the role of the interprofessional team in optimizing presurgical fitness and management of patients and enhancing postsurgical outcomes. Objectives: Identify risk factors for perioperative adverse cardiac events. Summarize preoperative cardiac risk using the American College of Cardiology/American Heart Association algorithm. Outline situations when elective surgeries should be delayed. Explain the importance of the interprofessional team in communicating with patients with cardiac disease to optimize presurgical fitness and in turn enhance postsurgical outcomes. Access free multiple choice questions on this topic.

Many patients undergoing major noncardiac as well as vascular surgery are at risk for a major adverse cardiac event (MACE). In the United States, 27 million patients undergo non-cardiac surgery annually, 50,000 of which suffer a postoperative myocardial infarction (MI). It's estimated that cardiovascular complications are responsible for roughly one-half of all the mortality experienced by patients undergoing noncardiac surgery and occur in 1% to 5% of patients undergoing vascular surgery.[1] To minimize perioperative complications and reduce morbidity and mortality, a thorough preoperative evaluation of patients with heart disease with appropriate risk stratification is necessary.[2] The American College of Cardiology (ACC) and the American Heart Association (AHH) have collaborated to develop a set of clinical practice guidelines using scientific evidence to standardize the preoperative cardiac evaluation of patients undergoing non-cardiac surgery. Recommendations have their basis on a known history of or risk factors for cardiac disease, the patient’s functional status, as well as the urgency of the procedure. The resulting individualized cardiac risk assessment reduces the risk of MACE, as it determines the need for further optimization of the patient with diagnostic testing, medical therapy, and even coronary interventions.[3]

To ensure an optimal perioperative course, a unified team approach with close cooperation between all physicians involved (surgeon, anesthesiologist, cardiologist, pulmonologist, primary care) is essential.[3] Despite many advances in evidence-based guidelines, cardiac complications after noncardiac surgery remain a substantial problem, and physicians work together to employ all evidence-based tools available to reduce morbidity and mortality and enhance patient outcomes.[4]