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Clinicians who provide preoperative consultation should pay attention to several new reports on cardiovascular assessment and management of patients who undergo noncardiac surgery.
The American College of Cardiology and American Heart Association have updated their 1996 guidelines on perioperative cardiovascular evaluation for noncardiac surgery. The new guidelines include an annotated algorithm that stratifies patients into those who may proceed immediately to surgery and those who might benefit from noninvasive testing; the algorithm incorporates clinical risk factors, the patient's functional capacity, and type of surgery. The underlying philosophy of the guidelines is that indications for cardiac testing (e.g., exercise or pharmacologic …