Requests for preoperative cardiology consultation for patients undergoing non cardiac surgery

AIMS: The number of surgical procedures performed in patients with significant ischemic heart disease is growing. The need for preoperative cardiology consultation in patients undergoing non-cardiac surgery has been the subject of continuous debate. We evaLuated if the requests for preoperative cardiology consultation in patients undergoing non-cardiac surgery were consistent with the 2009 ACC/AHA Guidelines. METHODS AND RESULTS: Patients referred for cardiology consultation before non-cardiac surgery were eligible for the study. Data were collected on age, gender, reasons for consultation, type of surgery, Lee's Cardiac Risk Stratification Class, therapy changes, patients work capacity, and perioperative patients' outcome. Our study population consisted of one hundred and seventy patients; 89 were men (52.3%) and 81 women (47.6%), with a mean age of 74.2±years; 88 patients (51.8%) had a work capacity ≥4 metabolic equivalents [METs). Active cardiac conditions were present in 12 patients (7.1%). The reported clinical risk factors were: 75 patients (44.1%) had diabetes mellitus, 21 patients (12.3%) had prior or compensated heart failure, 79 patients (46.5%) had ischemic heart disease, 29 patients (17.1%) had stroke, and 30 patients (17.7%) had renal insufficiency. Fourteen patients (8.2%) had an implanted pacemaker. There were also 3 perioperative deaths (1.8%). The indication of the requests for preoperative cardiac consultation according to the 2009 ACC/AHA Guidelines was only found in 45 patients (26.5%). CONCLUSIONS: Only in a minority of patients undergoing non-cardiac surgery, the preoperative cardiology consultation requests followed the ACC/AHA Guidelines. Preoperative cardiology consultations in the daily clinical practice are overused.