title: Cardiac assessment prior to non-cardiac surgery.
abstract: BACKGROUND
  Increasingly, patients undergoing non-cardiac surgery are older and have more comorbidities yet preoperative cardiac assessment appears haphazard and unsystematic. We hypothesised that patients at high cardiac risk were not receiving adequate cardiac assessment, and patients with low-cardiac risk were being over-investigated.
  
  
  OBJECTIVE
  To compare in a representative sample of patients undergoing non-cardiac surgery the use of cardiac investigations in patients at high and low preoperative cardiac risk.
  
  
  METHODS
  We examined cardiac assessment patterns prior to elective non-cardiac surgery in a representative sample of patients. Cardiac risk was calculated using the Revised Cardiac Risk Index.
  
  
  RESULTS
  Of 671 patients, 589 (88%) were low risk and 82 (12%) were high risk. We found that nearly 14% of low-risk and 45% of high-risk patients had investigations for coronary ischaemia prior to surgery. Vascular surgery had the highest rate of investigation (38%) and thoracic patients the lowest rate (14%). Whilst 78% of high-risk patients had coronary disease, only 46% were on beta-blockers, 49% on aspirin and 77% on statins. For current smokers (17.3% of cohort, n = 98), 60% were advised to quit pre-op.
  
  
  CONCLUSIONS
  Practice patterns varied across surgical sub-types with low-risk patients tending to be over-investigated and high-risk patients under-investigated. A more systemised approach to this large group of patients could improve clinical outcomes, and more judicious use of investigations could lower healthcare costs and increase efficiency in managing this cohort.
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.|Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: J F
authors.initials: JF
authors.lastname: Mooney
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: G S
authors.initials: GS
authors.lastname: Hillis
authors.affiliation: Centre for Transplant and Renal Research, Westmead Institute for Medical Research at University of Sydney, Sydney, New South Wales, Australia.
authors.forename: V W
authors.initials: VW
authors.lastname: Lee
authors.affiliation: Department of Anaesthetics, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Halliwell
authors.affiliation: Department of Vascular Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Vicaretti
authors.affiliation: Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Moncrieff
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.|Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: C K
authors.initials: CK
authors.lastname: Chow
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D001315:Australia; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000628:therapy*; D004358:Drug Therapy; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D011300:Preoperative Care / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D014656:Vascular Surgical Procedures
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin
keywords: cardiac; preoperative care; surgery