How to reduce your risk of heart attack and stroke before, during, and after surgery
New guidelines describe how to manage the risks of heart attacks and strokes before, during, and after surgery for patients whose conditions are not connected to their hearts.
The guidelines cover topics including how to minimise testing to avoid excessive expenditures and delays in surgery, as well as how to correctly control blood pressure and cardiac drugs. They are based on research that has been gathered over the previous ten years. The American College of Cardiology and the American Heart Association issued them. The new recommendations were approved by seven other medical associations.
The recommendations writing group’s lead author, Dr. Annemarie Thompson, stated in a press release that “there is a wealth of new evidence about how best to evaluate and manage perioperative cardiovascular risk in patients undergoing noncardiac surgery.” Thompson teaches community health, medicine, and anaesthesiology, 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 new recommendations were created for patients scheduled for non-heart surgery, taking into account their evaluation prior to surgery as well as their after care. They are intended for health professionals from a variety of professions. Patients with pulmonary hypertension, cardiac valve disease, hypertrophic cardiomyopathy, obstructive sleep apnoea, and history of stroke are among those who should follow these recommendations. These take the place of earlier, 2014-published guidelines.
“The U.S. population is getting older and is living longer with chronic health conditions, including chronic heart and vascular diseases,” Thompson stated. For patients with cardiovascular diseases and risk factors, “a multidisciplinary, team-based approach” including specialists, general practitioners, and surgeons is necessary to guarantee the best treatment possible prior to, during, and following surgery, the speaker stated.
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.
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