Cardiovascular Risk Assessment in the Older Adult: Don't Call It Cardiac Clearance!

Patients over the age of 65 account for 55% of all operative procedures performed in the US, and nearly 50% of Americans will have a surgical procedure after the age of 65 years. Some decline in function will occur in 35%, and over 20 % of them may not be able to return to live independently. Up to 50% of older adults experience some kind of complication related to hospitalization.

Advanced age does not preclude surgical interventions that can improve function or quality of life. A decrease in physiological reserves, the presence of multiple chronic conditions, and functional impairments have all been associated with increased risk for adverse surgical complications. Even patients without apparent deficits may have little functional reserve so that an acute illness or insult (such as a surgical procedure) can lead to disability and dependence.

The American Geriatric Society and American College of Surgeons provide a consensus guideline that address the perioperative care of the older adult. The American Society of Anesthesiologists follow a physical status classification system for the patient in their care. The American College of Cardiology and the American Heart Association provide a stepwise approach using multivariate risk indices to the preoperative assessment for patients undergoing non-cardiac surgery.

This presentation will provide the gerontological advanced practice nurse with tools to safely guide the cardiovascular risk assessment in the older adult in an ambulatory care or long-term setting. Application of a comprehensive geriatric assessment can enhance the decision-making for the potential surgical team and judiciously guide risk and benefit discussions in a shared decision-making context.