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In the 2014 guideline from the American College of Cardiology and American Heart Association on perioperative cardiovascular risk assessment before noncardiac surgery, clinicians are asked to assess functional capacity of patients whose risk for postoperative cardiac complications is estimated at ≥1% (NEJM JW Gen Med Dec 1 2014 and J Am Coll Cardiol 2014; 64:7). The guideline directs these higher-risk patients with functional capacity of ≥4 metabolic equivalents (METs) to surgery without further evaluation but directs those with poor functional capacity (<4 METs; e.g., inability to climb a flight of stairs) to undergo pharmacologic stress testing “if it will impact decision making.”
To examine associations between functional capacity and per…