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Evidence to Improve Care

Preoperative Cardiac Stress Tests for Noncardiac Surgery


Ontario Health Technology Advisory Committee Recommendations

  • The Ontario Health Technology Advisory Committee does not recommend the routine use of noninvasive cardiac stress tests for preoperative screening purposes prior to noncardiac, intermediate-risk, elective surgery.

  • The Ontario Health Technology Advisory Committee recommends that the selective use of these tests be guided based on patients' clinical risk factors for perioperative cardiac complications, as well as whether information from the test would inform clinical decision-making.

Read the full OHTAC Recommendation report



Preoperative cardiac assessment (checking the heart) is meant to find patients who might have serious heart problems if they have surgery. In fiscal year 2011/12, the Institute for Clinical Evaluative Sciences found about 7,500 preoperative assessments of cardiac risk had been performed through cardiac stress tests in Ontario.


Health Quality Ontario Reviews Preoperative Cardiac Stress Tests for Noncardiac Surgery

Noninvasive (without putting tools into the body) cardiac stress tests (checking the heart for problems that might appear when the patient is not relaxed) are often used to find serious heart problems that might appear during surgery. Three types of tests are used: stress echocardiography, radionuclide myocardial perfusion imaging, and exercise/treadmill test. These tests are not invasive and can allow surgeons to postpone surgery for a better time or to prepare for any problems that might develop.


Preoperative Cardiac Stress Tests for Noncardiac Surgery: A Rapid Review (PDF)
March 2014


Related Resources

Preoperative Consultations: OHTAC Recommendation (PDF)
March 2014


Preoperative Resting Echocardiography for Noncardiac Surgery: OHTAC Recommendation (PDF)
March 2014


Preoperative Consultations: A Rapid Review (PDF)
March 2014


Preoperative Resting Echocardiography for Noncardiac Surgery: A Rapid Review (PDF)
March 2014


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The Ministry of Health and Long-Term Care has accepted this recommendation.

The Ministry of Health and Long-Term Care has provided the following response: Relevant language in Schedule of Benefits for Physician Services has been updated.




Health Technology Assessment at Health Quality Ontario

As part of our core function to promote health care supported by the best available evidence, we use established scientific methods to analyze the evidence for a wide range of health interventions, including diagnostic tests, medical devices, interventional and surgical procedures, health care programs and models of care. These analyses are informed by input from a range of individuals, including patients and clinical experts. The Ontario Health Technology Advisory Committee (OHTAC) — a committee of the Health Quality Ontario board of directors — reviews the evidence and makes recommendations about whether health care interventions should be publicly funded or not. Draft recommendations are posted on the Health Quality Ontario website for feedback. Final recommendations are approved by our board of directors and then shared with the Ministry of Health and Long-Term Care. For more detailed information, visit our Evidence to Improve Care pages.


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