Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Cardiac Anesthesia Risk Evaluation (CARE) score is a clinical calculator used to assess the risk of perioperative cardiac complications in patients undergoing non-cardiac surgery. It is particularly useful in patients with known or suspected coronary artery disease. The CARE score takes into account factors such as age, type of surgery, history of myocardial infarction, angina, heart failure, stroke, diabetes, and renal insufficiency. The higher the score, the greater the risk of perioperative cardiac complications. This calculator is not applicable to patients undergoing cardiac surgery, as it is specifically designed for non-cardiac surgical procedures. The CARE score aids clinicians in decision-making regarding preoperative cardiac evaluation and management, and can guide discussions about surgical risk with patients.

Cardiac Anesthesia Risk Evaluation score (CARE score)

# Description:
The Cardiac Anesthesia Risk Evaluation (CARE) score is a clinical calculator used to assess the risk of perioperative cardiac complications in patients undergoing non-cardiac surgery. It is particularly useful in patients with known or suspected coronary artery disease. The CARE score takes into account factors such as age, type of surgery, history of myocardial infarction, angina, heart failure, stroke, diabetes, and renal insufficiency. The higher the score, the greater the risk of perioperative cardiac complications. This calculator is not applicable to patients undergoing cardiac surgery, as it is specifically designed for non-cardiac surgical procedures. The CARE score aids clinicians in decision-making regarding preoperative cardiac evaluation and management, and can guide discussions about surgical risk with patients.
---
# Inputs:
## Patient status
A. Stable cardiac disease, no other medical problems, undergoing non-complex surgery
B. Stable cardiac disease, one or more controlled medical problems, undergoing non-complex surgery
C. Any uncontrolled medical problem or undergoing complex surgery
D. Any uncontrolled medical problem and undergoing complex surgery
E. Chronic or advanced cardiac disease undergoing cardiac surgery as a last hope to save or improve life

## Emergency: surgery as soon as diagnosis is made and operating room is available
F. Yes
G. No
---
# Scoring:
- If A, then CARE 1. Risk of in-hospital mortality is 0.5% and morbidity is 5.4%
- If B, then CARE 2. Risk of in-hospital mortality is 1.1% and morbidity is 10.3%
- If C and G, then CARE 3. Risk of in-hospital mortality is 2.2% and morbidity is 19.0%
- If C and F, then CARE 3E. Risk of in-hospital mortality is 4.5% and morbidity is 32.1%
- If D and G, then CARE 4. Risk of in-hospital mortality is 8.8% and morbidity is 48.8%
- If D and F, then CARE 4E. Risk of in-hospital mortality is 16.7% and morbidity is 65.8%
- If E and G, then CARE 5. Risk of in-hospital mortality is 29.3% and morbidity is 79.6%
- If E and F, then CARE 5E. Risk of in-hospital mortality is 46.2% and morbidity is 88.7%
- If true, then Please make a selection)

The NYHA functional classification for heart failure, or New York Heart Association Functional Classification, is a scoring system used to quantify the severity of symptoms in patients with heart failure. This classification system is applicable to patients diagnosed with heart failure and is used to assess their functional capacity and limitations during physical activity. 

The NYHA classification is divided into four classes: Class I (no symptoms and no limitation in ordinary physical activity), Class II (mild symptoms and slight limitation during ordinary activity), Class III (marked limitation in activity due to symptoms, even during less-than-ordinary activity), and Class IV (severe limitations, experiences symptoms even while at rest).

The clinical utility of this calculator is to guide treatment decisions, assess prognosis, and evaluate the effectiveness of therapeutic interventions in patients with heart failure. It is also commonly used in clinical trials to stratify patients and measure outcomes. 

There are no specific exclusion criteria for its use, but it is subjective and relies on patient self-report, so it may not be as accurate in patients with cognitive impairment or communication difficulties.

NYHA functional classification for heart failure

# Description:
The NYHA functional classification for heart failure, or New York Heart Association Functional Classification, is a scoring system used to quantify the severity of symptoms in patients with heart failure. This classification system is applicable to patients diagnosed with heart failure and is used to assess their functional capacity and limitations during physical activity. 

The NYHA classification is divided into four classes: Class I (no symptoms and no limitation in ordinary physical activity), Class II (mild symptoms and slight limitation during ordinary activity), Class III (marked limitation in activity due to symptoms, even during less-than-ordinary activity), and Class IV (severe limitations, experiences symptoms even while at rest).

The clinical utility of this calculator is to guide treatment decisions, assess prognosis, and evaluate the effectiveness of therapeutic interventions in patients with heart failure. It is also commonly used in clinical trials to stratify patients and measure outcomes. 

There are no specific exclusion criteria for its use, but it is subjective and relies on patient self-report, so it may not be as accurate in patients with cognitive impairment or communication difficulties.
---
# Inputs:
## Physical ability
A. Patients with cardiac disease, but without limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea.
B. Patients with cardiac disease resulting in slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea.
C. Patients with cardiac disease resulting in marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, dyspnea or anginal pain.
D. Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure at rest, if any physical activity is undertaken, discomfort increases.
---
# Scoring:
- If A, then Class I
- If B, then Class II
- If C, then Class III
- If D, then Class IV
- If true, then Please make a selection)

The Revised Cardiac Risk Index (RCRI) is a clinical calculator used to estimate the risk of cardiac complications during the perioperative period in patients undergoing non-cardiac surgery. It is particularly useful for stratifying patients into different risk categories based on six identified risk factors: high-risk surgery, history of ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, insulin therapy for diabetes, and preoperative serum creatinine >2.0 mg/dL. 

The RCRI is not applicable to patients undergoing cardiac surgery, as it was specifically designed for non-cardiac surgical procedures. It also may not be as accurate in populations not represented in the original study, such as those with less common comorbidities or undergoing less common surgical procedures.

Revised Cardiac Risk Index for perioperative risks (RCRI)

# Description:
The Revised Cardiac Risk Index (RCRI) is a clinical calculator used to estimate the risk of cardiac complications during the perioperative period in patients undergoing non-cardiac surgery. It is particularly useful for stratifying patients into different risk categories based on six identified risk factors: high-risk surgery, history of ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, insulin therapy for diabetes, and preoperative serum creatinine >2.0 mg/dL. 

The RCRI is not applicable to patients undergoing cardiac surgery, as it was specifically designed for non-cardiac surgical procedures. It also may not be as accurate in populations not represented in the original study, such as those with less common comorbidities or undergoing less common surgical procedures.
---
# Inputs:
A. High-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular surgery) (+1)
B. History of ischemic heart disease (history of myocardial infarction/positive exercise test, ECG with pathological Q waves, current ischemic chest pain, or use of nitrate) (+1)
C. History of congestive heart failure (pulmonary edema, bilateral rales or S3 gallop, paroxysmal nocturnal dyspnea, pulmonary vascular redistribution on chest X-ray) (+1)
D. History of cerebrovascular disease (transient ischemic attack or stroke) (+1)
E. Use of insulin for diabetes (+1)
F. Preoperative creatinine > 2 mg/dL [> 178 mcmol/L] (+1)
---
# Scoring:
- If score == 0, then Risk of 30-day MI, cardiac arrest or mortality is 3.9%
- If score == 1, then Risk of 30-day MI, cardiac arrest or mortality is 6.0%
- If score == 2, then Risk of 30-day MI, cardiac arrest or mortality is 10.1% 
- If score >= 3, then Risk of 30-day MI, cardiac arrest or mortality is 15.0%)

Tricuspid regurgitation

Guidelines

Key sources