Stepwise approach to perioperative cardiac management can help doctors decide whether surgery should proceed
By Elana Gotkine HealthDay Reporter
TUESDAY, Oct. 1, 2024 (HealthDay News) — In a clinical practice guideline issued by the American College of Cardiology and American Heart Association, published online Sept. 24 in both Circulation and the Journal of the American College of Cardiology, updated recommendations are presented for the perioperative cardiovascular management of noncardiac surgery.
Annemarie Thompson, M.D., from Duke University Hospital in Durham, North Carolina, and colleagues note that a stepwise approach to perioperative cardiac assessment can help clinicians determine whether surgery should proceed or whether a pause for additional evaluation is necessary. For patients undergoing noncardiac surgery, cardiovascular screening and treatment should adhere to the same indications as for nonsurgical patients, with careful timing to avoid delays in surgery. Stress testing should be performed judiciously, especially for those at lower risk and only in those in whom testing would be appropriate, regardless of planned surgery.
When managing patients with complex anatomy or unstable cardiovascular disease, team-based care should be emphasized, the authors note. There are significant perioperative implications for new therapies for management of diabetes, heart failure, and obesity. To minimize the risk for perioperative ketoacidosis associated with their use, sodium glucose-cotransporter 2 inhibitors should be discontinued three to four days before surgery. Myocardial injury after noncardiac surgery is a newly identified disease process, which should not be ignored. The risk for stroke is increased for patients with newly diagnosed atrial fibrillation identified during or after noncardiac surgery. Only patients at highest risk for thrombotic complications should use perioperative bridging of oral anticoagulant therapy.
“This new guideline is a comprehensive review of the latest research to help inform clinicians who manage perioperative patients, with the ultimate goal of restoring health and minimizing cardiovascular complications,” Thompson said in a statement.
Several authors disclosed ties to the biopharmaceutical and medical device industries.
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