Preoperative cardiovascular assessment
Jun 23, 2025
Healthy hearts: preoperative cardiovascular assessment and optimisation 🫀
Our patients' surgical journey begins long before they enter the operating theatre. The preoperative period is a vital opportunity to identify cardiovascular risks for patients with known or potential heart disease, and optimise their health preoperatively to support positive outcomes postoperatively.
So how do we do this?
Structured guidelines, such as those published by the European Society of Cardiology (ESC), provide a framework for preoperative assessment, and recommendations for management optimisation of heart health before surgery. The guidelines include the following key elements:
🔸 Risk stratification:
Identification of patients with an elevated cardiovascular risk based on factors such as age, known heart disease, and the presence of other risk factors such as smoking, diabetes, and poor functional capacity.
🔸 Biomarker monitoring: 💉
For patients identified to be at risk, or those over the age of 65 years, it is recommended that high-sensitivity cardiac troponin (hs‑cTn) levels are monitored — including a pre-op baseline, then at 24 and 48 hours postoperatively. Elevated postoperative levels warrant further investigation for silent myocardial injury.
🔸 Optimising pharmacological agents: 💊
Depending on the type of cardiovascular medication, recommendations may be to continue or adjust these preoperatively. This is determined on a case-by-case basis, but generally medications such as beta-blockers and statins are continued, whereas others such as ACE inhibitors or ARBs are withheld on the day of surgery to avoid perioperative hypotension.
🔸 Co-morbidities:
A thorough investigation and evaluation of co-morbidities is recommended, including conditions such as valvular disease, heart failure, arrhythmias, chronic kidney disease, pulmonary hypertension, and diabetes. These should be optimised preoperatively where possible, and concerns flagged early.
The role of perioperative nurses here is critical in the handover of information and monitoring/updating of results such as troponin levels and medication compliance. These guidelines help provide structure and standardisation of care, promoting clear communication and shared goals for the broader perioperative team.
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Reference:
Halvorsen, S. et al. (2022) 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery: Developed by the task force for cardiovascular assessment and management of patients undergoing non-cardiac surgery of the European Society of Cardiology (ESC) Endorsed by the European Society of Anaesthesiology and Intensive Care (ESAIC). European Heart Journal. V 43(39) pp 3826-3924. https://doi.org/10.1093/eurheartj/ehac270
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