Cardiac

Perioperative Cardiovascular Assessment

Cardiac risk before non-cardiac surgery is rarely a single number. Start with an integrated assessment — surgical risk, functional capacity, and cardiac history together. Use RCRI when a validated score is needed. For AF-related decisions, use the condition-specific tools.

Recommended Starting Point

Perioperative Cardiovascular Assessment

Integrating functional capacity, cardiovascular history, and surgical risk

Guideline-based cardiovascular assessment before non-cardiac surgery

Surgical urgency
Active cardiac conditions
Surgical risk
Functional capacity (METs / DASI)
Cardiovascular history

Start Assessment

Core support tool

Risk score

Cardiac Risk Assessment (RCRI)

Score six clinical predictors to estimate MACE risk and determine whether cardiology evaluation is needed

Use alongside the Risk Navigator when a validated MACE risk score is needed

Calculate RCRI

Condition-specific tools

For atrial fibrillation and anticoagulation decisions

AF / Stroke

CHA₂DS₂-VASc Score

Estimate annual stroke risk in atrial fibrillation and guide perioperative anticoagulation decisions

Calculate CHA₂DS₂-VASc

AF / Bleeding

HAS-BLED Score

Quantify bleeding risk in anticoagulated AF patients and identify modifiable factors before adjusting therapy

Calculate HAS-BLED

Which tool for this patient?

Cardiac history before major surgery — safe to proceed, or refer first?Risk Navigator RCRI ≥ 3 — does this patient need cardiology evaluation?RCRI Patient has AF — how high is the perioperative stroke risk?CHA₂DS₂-VASc Starting anticoagulation — are the bleeding concerns manageable?HAS-BLED

Echo-based interpretation

TTE and intraoperative TEE tools for hemodynamic pattern interpretation are in the Echo section.

Go to Echo →

Learn More

Education

Cardiac Risk Cases

Clinical scenarios for perioperative cardiac risk — from exercise intolerance to elevated BNP