How to manage heart and stroke risks before, during and after non-heart surgery

By ľ¹ÏÖ±²¥ News

Namthip Muanthongthae/Moment via Getty Images
(Namthip Muanthongthae/Moment via Getty Images)

For people having surgery unrelated to their hearts, new guidelines detail how to manage heart and stroke risks before, during and after surgery.

The , based on evidence accumulated over the past decade, address issues such as how to minimize testing to avoid unnecessary costs and delays in surgery and how to properly manage blood pressure and heart medications. They were issued Tuesday by the ľ¹ÏÖ±²¥ and American College of Cardiology. Seven other medical societies endorsed the new guidelines.

"There is a wealth of new evidence about how best to evaluate and manage perioperative cardiovascular risk in patients undergoing noncardiac surgery," Dr. Annemarie Thompson, who led the guidelines writing group, said in . Thompson is a professor of anesthesiology, medicine and population health sciences at Duke University School of Medicine in Durham, North Carolina.

"Worldwide, there are approximately 300 million noncardiac surgeries each year, which underscores the need to summarize and interpret the evidence to assist clinicians in managing patients who present for surgery," she said.

The updated guidelines, which target health professionals across disciplines, were written for patients scheduled for non-heart surgery from the time they're evaluated before surgery through postoperative care. They include recommendations for patients with coronary artery disease, hypertrophic cardiomyopathy, heart valve disease, pulmonary hypertension, obstructive sleep apnea and previous stroke. They replace older guidelines published in 2014.

"The U.S. population is getting older and is living longer with chronic health conditions, including chronic heart and vascular diseases," Thompson said. "A multidisciplinary, team-based approach" that includes surgeons, primary care physicians and specialists is needed to ensure optimal care for people with cardiovascular conditions and risk factors before, during and after surgery, she said.

The new guidelines cover the use of cardiovascular testing and screening, patient evaluations and assessments and the most recent evidence for how to manage cardiovascular conditions in people who need any surgery that requires general or regional anesthesia.

They also include recommendations for people taking new therapies to manage diabetes, heart failure and obesity. Specifically, the guidelines recommend that sodium-glucose cotransporter-2 (SGLT2) inhibitors be discontinued three to four days before surgery to minimize the risk of complications. The guidelines also include recommendations for discontinuing and resuming the use of blood thinners.

"From prior studies, conditions such as high blood pressure, Type 2 diabetes, age older than 55 in men and 65 in women, smoking and obesity are known risk factors that predispose patients to cardiovascular disease," Thompson said. "Others have a family history of premature coronary artery disease, which can also put them at increased risk. These guidelines are written with the understanding that these and other cardiovascular risk factors and conditions can contribute to negative surgical outcomes if they are unrecognized or not optimized before surgery."

The updated guidelines also focus on the need for additional research in two areas.

One is a newly identified condition known as myocardial injury after noncardiac surgery, or MINS, which involves injury to the heart that occurs during or shortly after surgery. Little is known about what causes MINS or how to prevent or manage it.

More research is also needed to understand how to manage irregular heart rhythms that may occur during or after noncardiac surgery, which can increase the risk for stroke.


ľ¹ÏÖ±²¥ News Stories

ľ¹ÏÖ±²¥ News covers heart disease, stroke and related health issues. Not all views expressed in ľ¹ÏÖ±²¥ News stories reflect the official position of the ľ¹ÏÖ±²¥. Statements, conclusions, accuracy and reliability of studies published in ľ¹ÏÖ±²¥ scientific journals or presented at ľ¹ÏÖ±²¥ scientific meetings are solely those of the study authors and do not necessarily reflect the ľ¹ÏÖ±²¥â€™s official guidance, policies or positions.

Copyright is owned or held by the ľ¹ÏÖ±²¥., and all rights are reserved. Permission is granted, at no cost and without need for further request, for individuals, media outlets, and non-commercial education and awareness efforts to link to, quote, excerpt from or reprint these stories in any medium as long as no text is altered and proper attribution is made to ľ¹ÏÖ±²¥ News.

Other uses, including educational products or services sold for profit, must comply with the ľ¹ÏÖ±²¥â€™s Copyright Permission Guidelines. See full terms of use. These stories may not be used to promote or endorse a commercial product or service.

HEALTH CARE DISCLAIMER: This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your health care provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. If you are in the United States and experiencing a medical emergency, call 911 or call for emergency medical help immediately.