What is the process for conducting a cardiac clearance evaluation?

From the Guidelines

A cardiac clearance evaluation should follow a stepwise approach, starting with determining the urgency of surgery and assessing the patient's risk factors for coronary artery disease, as outlined in the 2014 ACC/AHA guideline 1. The process involves several key steps:

• Determining the urgency of surgery and assessing the patient's risk factors for coronary artery disease
• Estimating the perioperative risk of major adverse cardiac events (MACE) using tools like the American College of Surgeons NSQIP risk calculator or the Revised Cardiac Risk Index (RCRI)
• Evaluating the patient's functional capacity using an objective measure or scale, such as the Duke Activity Status Index (DASI)
• Considering stress testing or echocardiography for higher-risk patients or those with poor functional capacity
• Consulting with a cardiologist for patients with active cardiac conditions, multiple risk factors, or abnormal test results The goal of this evaluation is to identify patients who may need cardiac optimization before proceeding with surgery, potentially reducing perioperative cardiac complications. Key considerations include:
• The patient's medical history, including cardiac symptoms, risk factors, and functional capacity
• The results of basic tests, such as electrocardiogram (ECG), complete blood count, basic metabolic panel, and chest X-ray
• The need for additional testing, such as stress testing or echocardiography, based on the patient's risk profile and functional capacity
• The importance of clear communication among the perioperative team, including the surgeon, anesthesiologist, and cardiologist, to ensure that the patient's cardiovascular health is optimized before surgery 1.

From the Research

Cardiac Clearance Evaluation Process

The process for conducting a cardiac clearance evaluation involves several steps, including:

• Initial screening using history, physical examination, electrocardiogram, and chest x-ray film 2
• Assessment of patient history, vital signs, and physical examination related to the cardiac patient 3
• Use of noninvasive cardiac diagnostic testing, such as transthoracic echocardiography, stress testing, and cardiac magnetic resonance imaging 4
• Consultation and clinical assessment of the heart and cardiovascular system, including anatomy and physiology of the heart, pathology, and investigations to aid differential diagnosis and clinical reasoning 5

Key Components of Cardiac Clearance Evaluation

Key components of the evaluation process include:

• Patient history: eliciting information about symptoms, medical history, and risk factors 5
• Physical examination: assessing vital signs, cardiovascular system, and other relevant systems 3
• Diagnostic testing: selecting appropriate noninvasive tests based on patient population and clinical presentation 4
• Clinical assessment: integrating patient history, physical examination, and diagnostic test results to inform clinical decision-making 5

Considerations for Cardiac Clearance Evaluation

Considerations for the evaluation process include:

• The importance of initial screening and low-technology methods in guiding further evaluation 2
• The need for nurses to be knowledgeable about available noninvasive cardiac diagnostic testing and their limitations 4
• The importance of clinical assessment and differential diagnosis in identifying cardiac dysfunction and guiding management 5
• The role of stress echocardiography in diagnosing and assessing coronary heart disease, including the use of physical exercise, pharmacological agents, and pacing stress 6