When to Order Cardiac Clearance for Elderly Patients

"Does my patient need cardiac clearance before surgery?" is one of the most common questions care coordinators in SNFs and ALFs ask — and one that, if answered slowly, can delay surgeries by weeks. This guide answers the most important questions about pre-operative cardiac clearance in plain language.

What Is Cardiac Clearance?

Cardiac clearance is a formal evaluation by a cardiovascular specialist that confirms a patient's heart can safely tolerate a planned surgical procedure and general or regional anesthesia. The evaluation results in documentation — typically a clearance letter or risk assessment note — that the surgeon and anesthesiologist require before proceeding.

It is not a simple rubber stamp. A proper evaluation includes a review of the patient's cardiac history, current medications, functional capacity, recent labs and imaging, and usually an on-site EKG. If the evaluating clinician identifies findings that increase surgical risk — like uncontrolled heart failure, recent myocardial infarction, or a significant arrhythmia — they will communicate those to the surgical team and may recommend optimization before proceeding.

When Is It Required?

Most hospitals and surgical centers require cardiac clearance for patients with any of the following:

• Known coronary artery disease (CAD) or prior heart attack
• Congestive heart failure (CHF) or reduced ejection fraction
• Active or recently treated arrhythmia (particularly atrial fibrillation)
• History of cardiac device (pacemaker or ICD)
• Significant valvular heart disease
• Poorly controlled hypertension
• Age 70 or older undergoing intermediate to high-risk surgery
• Symptoms of chest pain, exertional dyspnea, or syncope

Even for patients without a cardiac history, surgeons may request clearance for procedures involving major anesthesia, prolonged operative time, or significant expected blood loss.

How Long Does It Take?

Traditional cardiology office appointments for pre-op clearance can take 1 to 3 weeks to schedule — and that delay can push back an already-scheduled surgery, sometimes causing it to be cancelled altogether. For patients awaiting orthopedic procedures, wound care surgeries, or other time-sensitive interventions, this delay is clinically and personally costly.

Mobile cardiology changes this. When your facility has a mobile cardiology partner, the evaluation can be conducted bedside — typically within 48 to 72 hours of referral. The provider performs the clinical evaluation on-site, generates the required documentation, and communicates directly with the surgical team.

What If the Patient Can't Travel?

This is precisely where mobile cardiology fills an unmet need. For patients in wheelchairs, those on multiple medications that complicate transport, or those who become medically unstable during transport, traveling to a cardiology office for pre-op clearance creates its own risk. A bedside evaluation eliminates that burden entirely.

What the Clearance Letter Includes

Our cardiac clearance evaluations produce full documentation including: cardiac risk stratification (low, intermediate, high), EKG results and interpretation, medication recommendations for the perioperative period, and any recommended follow-up prior to or after surgery. All documentation is provided to the referring surgeon and facility within 24 hours of the bedside evaluation.