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In Italy more than 90,000 patients are admitted every year for surgical treatment of hip fracture. In these elderly patients frailty and the presence of 2 or more comorbidities are associated with a prognosis both a 30 days and at 1 year. Heart failure and myocardial infarction are the more threatened cardiac complications and the more frequent causes of death in first 30 days after surgery for hip fracture. High risk patients may be identified by careful and rapid preoperative evaluation in order to decrease preventable in-hospital death in subjects patients candidate to narrow time-dependent surgery. In our review we tried to evaluate whether the ACC/AHA and ESC/ ESA guideline are effectively suitable for adequate cardiovascular assessment in this particular high risk population.