Cardiovascular risk management in the peri‐operative setting

Summary Peri‐operative cardiovascular events occur in up to 3% of patients undergoing non‐cardiac surgery. Accurate cardiovascular risk assessment is important in the peri‐operative setting, as it allows informed and shared decisions regarding the appropriateness of proceeding with surgery, guides s...

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Bibliographic Details
Published in:Medical journal of Australia 2023-07, Vol.219 (1), p.30-39
Main Authors: Mahendran, Shehane, Thiagalingam, Aravinda, Hillis, Graham, Halliwell, Richard, Pleass, Henry CC, Chow, Clara K
Format: Article
Language:English
Subjects:
Acute coronary syndrome
Cardiovascular Diseases - prevention & control
General surgery
Heart Disease Risk Factors
Humans
Monitoring, Physiologic
Perioperative care
Risk Assessment
Risk Factors
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Summary:Summary Peri‐operative cardiovascular events occur in up to 3% of patients undergoing non‐cardiac surgery. Accurate cardiovascular risk assessment is important in the peri‐operative setting, as it allows informed and shared decisions regarding the appropriateness of proceeding with surgery, guides surgical and anaesthetic approaches, and may influence the use of preventive medications and post‐operative cardiac monitoring. Quantitative risk assessment may also inform a reconsideration of choosing a more limited lower risk type of surgery, or conservative management. Pre‐operative cardiovascular risk assessment starts with clinical assessment and should include an estimate of functional capacity. Specialised cardiac investigations are rarely indicated specifically to assess pre‐operative cardiovascular risk. The decision regarding cardiac investigations is influenced by the nature, extent and urgency of surgery. The strategy of performing pre‐operative revascularisation to improve post‐operative outcomes is not evidence‐based and recent international guidelines recommend against this.
ISSN:0025-729X
1326-5377
DOI:10.5694/mja2.51988