Guidelines For Treating Patients With Heart Disease

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A panel of experts from the American College of Cardiology and the American Heart Association on Thursday issued new guidelines on performing noncardiac surgery on patients with heart disease, the New York Times reports. The 82-page guidelines will be published in the Oct. 23 issue of the journal Circulation.

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Therecommendations aim to reduce heart patients' risks during surgery andcover a number of issues, such as when to stop taking certain drugs andwhen to receive a stent or have coronary bypass surgery in advance of aseparate procedure. They were culled from a critical review of severalstudies, with a focus on studies published after the last set ofguidelines was released in 2002.

Some key points of theguidelines are that patients do not necessarily have to receive cardiacsurgery to fix minor problems before undergoing nonheart procedures.The panel says patients should be evaluated and treated beforenoncardiac surgery only if they have severe angina, late-stage heartfailure, serious arrhythmias or severe heart valve disease. Inaddition, the guidelines say patients should continue taking statinsbefore nonheart surgery and should stop taking anticlotting drugs foras short a duration as possible, according to the Times.

The panel also said that researchers should focus future studies on areas of the guidelines where data are lacking (Altman, New York Times, 9/28). Lee Fleisher, a professor at the University of Pennsylvania School of Medicinewho headed the panel, said, "In the past, we had to go on indefiniteevidence, but now there are a number of studies published to help usdirect best practices." Fleisher said that if the condition is notsevere, "fixing the heart first doesn't make much of a difference inhow well they do in surgery," adding, "There is certainly no evidenceit will make any difference when it comes to outcome" (Stewart, Newark Star Ledger, 9/28).
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