Diagnostic Characteristics of Patient Self-Assessment of Preoperative Cardiac Risk for Non-Cardiac Surgery - Foundations for Patient Driven Decision Support

Introduction Surgery is a frequent health care intervention with an estimated 6 million non-cardiac surgical procedures performed every year in the United States, with progressive growth in the number of procedures noted each subsequent year(1). Preoperative medical evaluations have been a cornerstone of pre-surgical care planning and patient management. The clinical providers who carry out these pre-operative evaluations are guided by their medical knowledge, institutional policies and clinical practice guidelines. To address the challenge of standardizing the evaluation and management of perioperative cardiovascular complications of non-cardiac surgery, the American College of Cardiology/American Heart Association (ACC/AHA) issued perioperative guidelines for non-cardiac surgery in 2007 with a focused update on preoperative beta blockade in 2009(2), followed by the latest update in 2014 (3). These guidelines modified recommendations on the Revised Cardiac Risk Index (RCRI) (4,5) to highlight a set of conditions associated with higher post-operative morbidity and mortality for patients undergoing non-cardiac surgery.