Preprocedural Cardiovascular Evaluation in the Real World: Prevalence, Patterns, and Practice Gaps

Preoperative and prechemotherapy cardiovascular evaluations play a pivotal role in identifying undiagnosed pathologies and optimizing clinical outcomes. This multicenter retrospective cohort study analyzed 312 patients undergoing cardiovascular assessment prior to elective surgery or chemotherapy (2017–2025) to determine the prevalence, clinical significance, and management implications of newly diagnosed cardiovascular conditions. Key findings revealed a 15.1% prevalence of new pathologies, predominantly left ventricular hypertrophy (34.0%), valvular abnormalities (19.1%), and carotid plaques (12.8%), with prevalence escalating to 25.0% in patients aged ≥81 years. Management changes occurred in 85.1% of cases, primarily through medication initiation (beta-blockers, angiotensin receptor blockers) and additional testing, while procedural postponement was rare (2.6%). Age and procedural risk strongly influenced pathology detection, with vascular surgeries (23.3%) and prechemotherapy evaluations (22.2%) demonstrating the highest diagnostic yield. Notably, 7.6% of patients without prior comorbidities exhibited occult cardiovascular disease, challenging assumptions of low risk in asymptomatic populations. These findings align with ESC guidelines advocating risk-stratified evaluation for elderly and high-risk surgical/oncological patients (Halvorsen et al., 2022; Lyon et al., 2022). The study underscores the clinical utility of systematic cardiovascular screening to guide perioperative and oncological decision-making, emphasizing the need for standardized protocols to address practice variability. Future research should prioritize prospective validation of screening strategies and long-term outcome assessments.