People with heart disease should take special precautions before undergoing any kind of surgery, even noncardiac surgery, to reduce their risk of a cardiac event, according to new joint guidelines from the American College of Cardiology and the American Heart Association.
The American College of Cardiology/American Heart Association 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery will be published online ahead of print on September 27 in the October 23, 2007, issues of Circulation: Journal of the American Heart Association and the Journal of the American College of Cardiology.
The guidelines an update of those published in 2002 provide a framework for considering a persons risk of a cardiac event in the perioperative (during or immediately after) period of noncardiac surgery.
According to the recommendations, patients should not stop taking cholesterol-lowering drugs before surgery. In addition, the guidelines say that many people with heart disease can safely undergo noncardiac surgery without first fixing their heart disease with an artery-opening procedure or coronary bypass grafting. The guidelines also address how best to treat those people who need a heart procedure before noncardiac surgery, have coronary stents or require anti-clotting medication.
In the past we had to go on indefinite evidence, but now there are a number of studies published to help us direct best practices, said Lee A. Fleisher, M.D., chair of the guideline writing committee. Statin use wasnt even addressed in the previous guidelines. New trials have shown us that patients should continue taking them.
In the case of non-emergency or elective procedures, the guidelines say that intervention (such as bypass surgery or angioplasty) is rarely necessary to lower the risk of surgery unless a patient would need the intervention anyway. If the noncardiac surgery is an emergency, heart testing should be forgone and a
|Contact: Cathy Lewis|
American Heart Association