The article by Devereaux and colleagues1 documenting the underuse of validated cardiac risk indices by medical consultants evaluating patients undergoing noncardiac surgery highlights the real "bench to bedside" challenge we face. The science of cardiac risk assessment has come a long way, with over 20 years of published studies on cardiac risk assessment, validation of numerous risk prediction rules, and promulgation of several national guidelines. However, there appears to be very limited diffusion of these findings into real-world practice, even in the university teaching hospitals studied in this report.