Patient handout

Preoperative Cardiac Risk Evaluation (Noncardiac Surgery)

PRODUCTION

1. Your condition

This handout is for preoperative cardiac risk evaluation (noncardiac surgery). Your care team identified this based on: planned noncardiac surgery — preoperative clinic referral (2024 aha/acc perioperative).

Other reasons your team may use this plan: history of ischemic heart disease / prior mi / pci / cabg (rcri element) (lee 1999 pmid 10477528); history of chf (rcri element) (lee 1999 pmid 10477528); history of stroke / tia (rcri element) (lee 1999 pmid 10477528).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
metoprolol succinate	25-200 mg PO daily (continue chronic dose; do not initiate within 1 day pre-op)	PO	once daily	CONTINUE chronic beta-blocker — Class I 2024 AHA/ACC Perioperative (PMID 39316661). POISE 2008 (PMID 18479744): INITIATING metoprolol succinate within 1 day of surgery -> reduced MI (HR 0.73) but INCREASED total death (HR 1.33) and stroke (HR 2.17). Class III for new initiation just before surgery.
metoprolol	Per chronic regimen (do not initiate just pre-op)	PO	BID	Continue chronic metoprolol tartrate; alternative when extended-release unavailable (2024 AHA/ACC Perioperative)

Plan: Perioperative cardiac medication management — by class + indication (2024 AHA/ACC Perioperative)

3. When to call your provider

Contact your care team if any of the following happen:

Active cardiac condition (unstable angina, decompensated HF, severe AS, uncontrolled arrhythmia) -> POSTPONE + cardiology consult (2024 AHA/ACC Perioperative)
Recent MI <60d -> postpone elective surgery (2024 AHA/ACC Perioperative)
Recent DES <6mo / BMS <30d -> postpone elective (2024 AHA/ACC Perioperative)
New murmur on exam -> echo before surgery (2024 AHA/ACC Perioperative)
RCRI >=3 + functional capacity <4 METs + high-risk surgery -> stress test consideration if will change management (2024 AHA/ACC Perioperative)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Unstable angina / decompensated HF / severe AS / uncontrolled arrhythmia — POSTPONE elective noncardiac surgery (2024 AHA/ACC Perioperative)
MI within 60 days — postpone elective surgery; balance with surgical urgency (2024 AHA/ACC Perioperative)
DES placed within 6 months / BMS within 30 days — postpone elective surgery; continue DAPT if must proceed urgently (2024 AHA/ACC Perioperative)
Severe AS (AVA <1.0, mean gradient >40, peak velocity >4) — postpone or transcatheter valve before surgery (2024 AHA/ACC Perioperative)

5. Follow-up

Post-discharge cardiology follow-up if MINS / new MI / new arrhythmia; resume held meds (ACEi/ARB / antithrombotics) per surgical bleeding clearance; vaccination, lifestyle counseling (2024 AHA/ACC Perioperative)

6. Sources

Guideline: 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery (Thompson 2024) — supersedes 2014 ACC/AHA