The Critical Role of Cardiology Follow-Up in Perioperative Care

A large multicenter cohort study found a notable incidence of postoperative myocardial injury and linked routine cardiology follow-up with substantially lower 1-year mortality and major cardiac events.

Approximately 4.2 million people die within 30 days of surgery worldwide each year, and a substantial proportion of these deaths relate to unrecognized cardiac injury. Perioperative myocardial injury is frequently clinically silent: many patients lack ischemic symptoms despite significant troponin rises.

Detection gaps persist because peri-operative myocardial injury is often missed in routine clinical practice in the absence of active surveillance, and limited cardiology involvement may delay timely diagnosis and management. Missed recognition therefore translates into lost opportunities to intervene and reduce downstream cardiac events and deaths.

Cardiology evaluations after surgery were associated with a 35% lower 1-year mortality and a 46% lower rate of major cardiac events; these effect sizes indicate a strong association between postoperative specialist involvement and improved outcomes. Cardiologist follow-up correlated with greater use of cardiac imaging and guideline-directed pharmacotherapy among affected patients. The evidence derives from an observational natural-experiment design, so residual confounding cannot be excluded; nonetheless, the magnitude and consistency of the associations are clinically notable.

These findings suggest that structured postoperative cardiology engagement may be associated with improved one-year outcomes and warrants further prospective evaluation.

One operational consideration raised by the findings is the role of active peri-operative myocardial injury surveillance to enable early identification of occult injury in high-risk surgical patients.

The study also highlights broader implementation challenges, including how to prioritize cardiology involvement when specialist resources are constrained and how to structure follow-up care after discharge. These potential operational approaches were not formally tested in the study and should be viewed as areas for future prospective evaluation to assess feasibility, cost-effectiveness, and patient-centered benefit.

Key Takeaways:

• A large cohort links postoperative myocardial injury detection and cardiology engagement to lower one‑year mortality and fewer major cardiac events.
• Who’s affected? Older adults and patients with preexisting cardiovascular disease undergoing noncardiac surgery carry the highest postoperative risk.
• Targeted troponin screening and structured cardiology pathways are positioned for pragmatic evaluation in trials and quality‑improvement programs.