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4 Pre-operative assessment tools 4.1 Risk scores 4.1.1. General risk calculators Several risk indices have been developed based on multivariable analyses of observational data and have been validated during the last decade (Table 6).47,49,76 Most risk calculators integrate both patient-related and surgery-related risk factors, but none of them include biomarkers among their variables. Calculators for most of the commonly used risk indices are available online (Table 6). The risk calculators can be used in addition, or as an alternative, to the assessment of surgery-related and patient-related risk factors described in Section 3.3. The Task Force decided against recommending one specific risk score. The Task Force also decided that the selection criteria for further pre-operative testing should be clinical criteria, and not based on a specific score. Recommendation Table 5 — Recommendations for patient information Recommendations Classa Levelb It is recommended to give patients individualized instructions for pre-operative and post-operative changes in medication, in verbal and written formats with clear and concise directions. I C It should be considered to set up a structured information list (e.g. a check list to help with common issues) for patients with CVD or at high risk of CV complications scheduled for NCS. IIa C © ESC 2022 CV, cardiovascular; CVD, cardiovascular disease; NCS, non-cardiac surgery. aClass of recommendation. bLevel of evidence. Do I need to take any cardioprotective medication before surgery? Who will inform my cardiologist about my surgery? Do I need to pause or reduce any of my medications, and what are the risks if I do so? Who will take care of me and how will they communicate my history and needs during my hospital stay? Can my heart medications cause any problems during surgery? Are there any interactions or contraindications between my medications and drugs given during surgery? How will the healthcare professionals involved in my care be informed about my heart condition? Can you give me information on how I will be monitored before, during, and after surgery? Figure 3 Examples of questions and concerns expressed by patients. ESC Guidelines 3847 Downloaded from academic.oup.com/eurheartj/article/43/39/3826/6675076 by guest on 07 October 2026