Aging is a universal and progressive physiological process characterized by changes in organ and tissue structure as well as functional status(1). As people get older, their hearts and arteries go through a variety of anatomical and functional changes. Moreover, the prevalence of cardiovascular diseases such as systemic hypertension, atherosclerosis, acute myocardial infarction, and congestive heart failure has increased, further limiting the cardiovascular system's function(2).
Surgical interventions in elderly patients are associated with increased rates of morbidity and mortality, possibly due to an increased prevalence of comorbidities, decreased physiological reserve, or both (3). The aim of the preoperative assessment is to reduce perioperative surgical and anesthetic complications and to optimize them as early as possible through history, clinical examination, and investigations(4, 5).
According to the American Society of Anesthesiologists (ASA) task force on preanesthesia evaluation preoperative investigations are classified as routine and indicated. Routine tests are those performed without any special clinical rationale or aim including a panel of blood, urine tests, and chest x-ray, and ECG) and Indicated tests are those performed for a specific clinical indication or goal, such as confirming a clinical diagnosis, assessing the severity and the progression of disease, or determining the efficacy of medication(6).
Of all investigations, ECG was commonly ordered investigation for the elderly due to the prevalence of age-related cardiovascular changes. ECG is a sophisticated galvanometer and sensitive electromagnet that can detect and record changes in electromagnetic potentials. The ECG (12-lead) is the primary clinical tool for noninvasive assessment of cardiac electrical function and is one of the most widely used, inexpensive, and convenient assessment modalities used to screen for cardiovascular disease(7, 8).
Due to their age and the prevalence of multiple comorbidities, elderly surgical patients are at increased risk of preoperative ECG abnormalities. Elderly patients are more likely to have cardiovascular disease, cerebrovascular disease, and diabetes mellitus, all of which increase the overall risk of the cardiovascular system(3).
Abnormal electrocardiograms become more common as people get older. Evidence showed that the prevalence of abnormal ECG is high in the elderly population. Studies conducted in the United States, China, Brazil, and Nigeria showed that the prevalence of abnormal ECGs was 75.2%, 75.2%, 88.85%, and 70%, respectively (9–12).
According to the American College of Cardiology/American Heart Association (ACC/AHA) guideline, Surgical procedures are classified as low (< 1%), intermediate (1–5%), or high (> 5%) risk for the development Perioperative Cardiac Events (PCE) within 30 days after surgery.Preoperative ECG is not recommended for patients undergoing low-risk surgery but is indicated for patients with risk factors such as known heart disease, peripheral arterial disease, cerebrovascular disease, or other significant structural heart disease (13).
Previous studies in this area have had inconsistent results on the prevalence and associated factors of abnormal ECG.In addition, no consensus on the lowest age for routine preoperative ECG in elderly patients presenting for surgery, particularly in patients without specific risks. The present study aimed to evaluate the prevalence and contributing factors of preoperative ECG abnormalities in elderly surgical patients aged 50 years and older.