scholarly journals The Use of Lee and Co-Workers’ Index to Assist a Risk Adjusted Audit of Perioperative Cardiac Outcome

2008 ◽  
Vol 36 (2) ◽  
pp. 167-173 ◽  
Author(s):  
P. J. Moran ◽  
T. Ghidella ◽  
G. Power ◽  
A. S. Jenkins ◽  
D. Whittle
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Positive Result ◽  
Cardiac Event ◽  
Risk Index ◽  
Cardiac Risk ◽  
Noncardiac Surgery ◽  
Frequent Use ◽  
Cardiac Outcome ◽  
The Impact

Lee and co-workers’ revised cardiac risk index was used to study the perioperative cardiac outcome of 296 patients. The index uses a history of ischaemic heart disease, congestive cardiac failure, diabetes treated with insulin, a creatinine greater than 180 μmol/l, cerebrovascular disease and high risk surgery as the risk factors involved in predicting a perioperative cardiac event. It was derived on the basis of data from patients over the age of 50 years undergoing elective, noncardiac surgery with an expected inpatient stay of two or more days. The presence of one, two and three or more risk factors predicted a risk of a major cardiac event of 1.3% (95% confidence interval [CI] 0.7 to 2.1), 3.6% (95% CI 2.1 to 5.6) and 9% (95% CI 5.5 to 13.8) respectively in Lee's derivation group of 2,893 patients. In our audit of 296 patients we observed a cardiac event rate of 0.8% (95% CI 0 to 2.3%), 6.7% (95% CI 1.6 to 10%) and 2% (95% CI 0 to 5.9%), in patients with one, two and three or more risk factors respectively. The more frequent use of ECGs and troponin levels in the routine postoperative care of high risk patients undergoing major noncardiac surgery is recommended on the basis of the frequency of a positive result and the impact of a positive result on a patient's management.

The prevalence of cardiac risk factors in men with localized prostate cancer undergoing androgren deprivation therapy in British Columbia, Canada.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16086-e16086
Author(s):  
Jennifer Rajala ◽  
Scott Tyldesley ◽  
Tom Pickles ◽  
Sean Virani
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
British Columbia ◽  
High Risk ◽  
Cardiac Event ◽  
Cardiac Risk ◽  
Localized Prostate Cancer ◽  
Cardiac Risk Factors ◽  
Framingham Risk ◽  
History Of

e16086 Background: While androgen deprivation therapy (ADT) decreases the risk of prostate cancer specific mortality in high risk localized prostate cancer treated with radiotherapy, it worsens cardiovascular (CV) risk factor profiles in treated men. Patients with pre-existing traditional cardiac risk factors who are treated with ADT have a higher rate of CV mortality than patients without risk factors. Methods: We retrospectively reviewed the charts of the last 100 consecutive men with intermediate or high risk localized prostate cancer who were referred to the British Columbia Cancer Agency from October 1, 2011 to October 31, 2012 and treated with ADT. Inclusion criteria were referral to an oncologist within 3 months of diagnosis and a planned duration of ADT of 6 month or more. Patients with metastatic prostate cancer at diagnosis were excluded. Data on traditional cardiac risk factors were collected and a Framingham risk score was calculated on each patient to estimate their 10 year cardiac event risk. Results: The average age of the men referred for ADT was 71.7±7 years. Most, 70%, had poorly differentiated disease and the PSA was >10ug/L in 62%. An updated Charlson score of 0 was calculated in 82% of patients; only 4% had a score ≥2. The Framingham risk of a cardiac event in the next 10 years was calculated to be high (more than 20% risk) in 69%, intermediate (a 10-20% risk) in 30%, and low (<10% risk) in 1% of the patients. A history of coronary artery disease was present in 17 patients, 11 of whom had documented revascularization. Baseline type 2 diabetes or impaired glucose tolerance was present in 24 patients, and 58 patients had a history of hypertension. Lipid profiles had been measured within the past year in 38 patients, and 35 patients had a baseline ECG on the chart. Conclusions: Given the high prevalence of cardiac risk factors in men with prostate cancer referred for ADT, we recommend baseline cardiac risk screening of lipids, blood glucose, and blood pressure in these patients with subsequent close monitoring of these parameters while on ADT. Among those individuals with established or symptomatic CV disease, we recommend referral to a specialist with expertise in cardiology.

scholarly journals Patient Selection for Routine Troponin Monitoring After Noncardiac Surgery

2021 ◽  
Author(s):  
Corien S. A. Weersink ◽  
Judith A. R. van Waes ◽  
Remco B. Grobben ◽  
Hendrik M. Nathoe ◽  
Wilton A. van Klei
Keyword(s):  
High Risk ◽  
Troponin I ◽  
Elective Surgery ◽  
Risk Index ◽  
Regression Tree ◽  
Cardiac Risk ◽  
Noncardiac Surgery ◽  
Classification And Regression Tree ◽  
Regression Tree Analysis ◽  
Number Needed To Screen

Background Myocardial infarction is an important complication after noncardiac surgery. Therefore, perioperative troponin surveillance is recommended for patients at risk. The aim of this study was to identify patients at high risk of perioperative myocardial infarction (POMI), in order to aid appropriate selection and to omit redundant laboratory measurements in patients at low risk. Methods and Results This observational cohort study included patients ≥60 years of age who underwent intermediate to high risk noncardiac surgery. Routine postoperative troponin I monitoring was performed. The primary outcome was POMI. Classification and regression tree analysis was used to identify patient groups with varying risks of POMI. In each subgroup, the number needed to screen to identify 1 patient with POMI was calculated. POMI occurred in 216 (4%) patients and other myocardial injury in 842 (15%) of the 5590 included patients. Classification and regression tree analysis divided patients into 14 subgroups in which the risk of POMI ranged from 1.7% to 42%. Using a risk of POMI ≥2% to select patients for routine troponin I monitoring, this monitoring would be advocated in patients ≥60 years of age undergoing emergency surgery, or those undergoing elective surgery with a Revised Cardiac Risk Index class >2 (ie >1 risk factor). The number needed to screen to detect a patient with POMI would be 14 (95% CI 14–14) and 26% of patients with POMI would be missed. Conclusions To improve selection of high‐risk patients ≥60 years of age, routine postoperative troponin I monitoring could be considered in patients undergoing emergency surgery, or in patients undergoing elective surgery classified as having a revised cardiac risk index class >2.

Major Cardiac Events in Patients Admitted to Intensive Care After Vascular Noncardiac Surgery: A Retrospective Cohort

2019 ◽  
Vol 23 (3) ◽  
pp. 293-299 ◽  
Author(s):  
Pedro Videira Reis ◽  
Ana Isabel Lopes ◽  
Diana Leite ◽  
João Moreira ◽  
Leonor Mendes ◽  
...  
Keyword(s):  
High Risk ◽  
Characteristic Curve ◽  
Risk Index ◽  
Previous History ◽  
Predictive Ability ◽  
Cardiac Risk ◽  
Noncardiac Surgery ◽  
Intermediate Risk ◽  
Cardiac Events ◽  
Predictive Capacity

Introduction. Patients proposed to vascular noncardiac surgery (VS) have several comorbidities associated with major adverse cardiac events (MACE). We evaluated incidence, predictors, and outcomes, and compared different scores to predict MACE after VS. Methods. We included all patients admitted from 2006 to 2013. Perioperative MACE included cardiac arrhythmias, myocardial infarction (MI), cardiogenic pulmonary edema (CPE), acute heart failure (AHF), and cardiac arrest (CA). Lee Revised Cardiac Risk Index (RCRI), Vascular Quality Initiative (VQI-CRI), Vascular Study Group of New England (VSG-CRI), and South African Vascular Surgical (SAVS-CRI) Cardiac Risk Indexes were calculated and analyzed. We performed multivariate logistic regression to assess independent predictors with calculation of odds ratio (OR) and 95% confidence interval (CI). To reduce overfitting, we used leave-one-out cross-validation approach. The Predictive ability of scores was tested using area under receiver operating characteristic curve (AUROC). Results. A total of 928 patients were included. We observed 81 MACE (28 MI, 22 arrhythmias, 10 CPE, 9 AHF, 12 CA) in 60 patients (6.5%): 3.3% in intermediate-risk surgery and 9.8% in high-risk surgery. Previous history of coronary artery disease (OR = 3.2, CI = 1.8-5.7), atrial fibrillation (OR = 5.1, CI = 2.4-11.0), insulin-treated diabetes mellitus (OR = 3.26, CI = 1.51-7.06), mechanical ventilation (OR = 2.75, CI = 1.41-4.63), and heart rate (OR = 1.02, CI = 1.01-1.03) at admission were considered independent risk factors in multivariate analysis. The AUROC of our model was 0.79, compared with RCRI (0.66), VSG-CRI (0.69), VQI-CRI (0.71), and SAVS-CRI (0.73). Conclusions. Observed MACE were within predicted range (1% to 5% after intermediate-risk surgery and >5% after high-risk surgery). SAVS-CRI and VQI-CRI had slightly better predictive capacity than VSG-CRI or RCRI.

The impact of multiple high-risk factors on survival outcome of surgically treated early-stage cervical cancer

2014 ◽  
Vol 133 ◽  
pp. 62
Author(s):  
K. Matsuo ◽  
S. Mabuchi ◽  
M. Okazawa ◽  
Y. Matsumoto ◽  
K. Yoshino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
High Risk ◽  
Early Stage ◽  
Survival Outcome ◽  
High Risk Factors ◽  
Early Stage Cervical Cancer ◽  
The Impact

Abstract 12444: Outcomes After Starting Beta-Blockade Within a Clinically Sensible Period Before Major Elective Noncardiac Surgery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Duminda N Wijeysundera ◽  
Dennis T Ko ◽  
Harindra C Wijeysundera ◽  
Lingsong Yun ◽  
W. Scott Beattie
Keyword(s):  
Cohort Study ◽  
Beta Blockers ◽  
Risk Index ◽  
Cardiac Risk ◽  
Population Based ◽  
Noncardiac Surgery ◽  
Beta Blockade ◽  
Matched Cohort ◽  
Post Surgery ◽  
Median Daily Dose

INTRODUCTION: Guidelines recommend that perioperative beta-blockade be started days to weeks before surgery. Nonetheless, all randomized trials except for the controversial DECREASE trials started treatment ≤1 day before surgery, while most observational studies did not distinguish between long-term beta-blockade versus beta-blockers started for perioperative reasons. We thus conducted a population-based cohort study of the effectiveness of beta-blockade started within a clinically sensible period (8-60 days) before surgery. METHODS: Following research ethics approval, we conducted a cohort study of patients (≥66 years) who underwent major elective noncardiac surgery from 2003 and 2012 in Ontario, Canada. Propensity-score methods were used to form a matched cohort that reduced important differences between patients who started beta-blockers 8-60 days before surgery versus controls (no beta-blockers within 1 year before surgery). We measured the association of beta-blockade with 30-day (death, MI, stroke) and 1-year (death) outcomes post-surgery. Subgroup analyses were performed based on Revised Cardiac Risk Index class and history of prior CAD. RESULTS: The cohort included 4268 beta-blocked patients and 154,357 controls. Metoprolol (median daily dose 50 mg) was prescribed to 36% of beta-blocked patients, atenolol (median 25 mg) to 26%, and bisoprolol (median 5 mg) to 37%. In the matched cohort (n=8492), beta-blockade was not associated with death (RR 0.96; CI 0.70-1.32), MI (RR 0.92; CI 0.72-1.17), and stroke (RR 1.31; CI 0.68-2.52) at 30-days, or death at 1-year (Figure). Associations with outcomes did not differ significantly across subgroups. CONCLUSIONS: Outcomes were not altered in patients who start perioperative beta-blockade within a clinically sensible period before surgery. A large randomized trial is needed to determine if the continued use of perioperative beta-blockade in clinical practice is justified.

Second Primary Melanoma: Risk Factors, Histopathologic Features, Survival, and Implications for Follow-Up

2016 ◽  
Vol 82 (10) ◽  
pp. 1009-1013 ◽  
Author(s):  
Maris S. Jones ◽  
Hitoe Torisu-Itakura ◽  
Devin C. Flaherty ◽  
Hans F. Schoellhammer ◽  
Jihey Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Cutaneous Melanoma ◽  
Primary Melanoma ◽  
Second Primary ◽  
Melanoma Risk ◽  
Impact On Survival ◽  
The Impact ◽  
Histopathologic Features

The impact on survival of a second primary melanoma (SPM) is unclear. We used our melanoma center's database to examine clinicopathologic risk factors and outcomes of stage 0 to IV cutaneous melanoma in patients with one versus two primaries. Among 12,325 patients with primary melanoma, 969 (7.86%) developed SPM. SPMs were significantly thinner than autologous primary melanomas ( P = 0.01), and 451 SPM patients had better overall and melanoma-specific survival than 451 prognostically matched non-SPM patients ( P < 0.0001 and 0.0001, respectively) at a median follow-up of 142.37 months. Patients with cutaneous melanoma are at high risk for development of SPM, but the development of SPM does not seem to impair survival.

Modifying Pro-Drug Risk Factors in Adolescents: Results From Project ALERT

2004 ◽  
Vol 31 (3) ◽  
pp. 318-334 ◽  
Author(s):  
Bonnie Ghosh-Dastidar ◽  
Douglas L. Longshore ◽  
Phyllis L. Ellickson ◽  
Daniel F. McCaffrey
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Drug Use ◽  
Eighth Graders ◽  
Risk Groups ◽  
Drug Prevention ◽  
School Environments ◽  
School Based ◽  
Drug Risk ◽  
The Impact

The objective of this study was to evaluate the impact of a revised state-of-the-art drug prevention program, Project ALERT, on risk factors for drug use in mostly rural midwestern schools and communities. Fifty-five middle schools from South Dakota were randomly assigned to treatment or control conditions. Treatment-group students received 11 lessons in Grade 7 and 3 more in Grade 8. Effects for 4,276 eighth graders were assessed 18 months after baseline. Results indicate that Project ALERT had statistically significant effects on all the targeted risk factors associated with cigarette and marijuana use and more modest gains with the pro-alcoholrisk factors. The program helped adolescents at low, moderate, and high risk for future use, with the effect sizes typically stronger for the low- and moderate-risk groups. Thus, school-based drug prevention programs can lower risk factors that correlate with drug use, help low- to high-risk adolescents, and be effective in diverse school environments.

scholarly journals Insulin Resistance and Atherosclerosis: Implications for Insulin-Sensitizing Agents

2019 ◽  
Vol 40 (6) ◽  
pp. 1447-1467 ◽  
Author(s):  
Antonino Di Pino ◽  
Ralph A DeFronzo
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Insulin Resistance ◽  
High Risk ◽  
Cardiometabolic Risk ◽  
Considerable Evidence ◽  
Risk Patients ◽  
Cv Disease ◽  
The Impact

Abstract Patients with type 2 diabetes mellitus (T2DM) are at high risk for macrovascular complications, which represent the major cause of mortality. Despite effective treatment of established cardiovascular (CV) risk factors (dyslipidemia, hypertension, procoagulant state), there remains a significant amount of unexplained CV risk. Insulin resistance is associated with a cluster of cardiometabolic risk factors known collectively as the insulin resistance (metabolic) syndrome (IRS). Considerable evidence, reviewed herein, suggests that insulin resistance and the IRS contribute to this unexplained CV risk in patients with T2DM. Accordingly, CV outcome trials with pioglitazone have demonstrated that this insulin-sensitizing thiazolidinedione reduces CV events in high-risk patients with T2DM. In this review the roles of insulin resistance and the IRS in the development of atherosclerotic CV disease and the impact of the insulin-sensitizing agents and of other antihyperglycemic medications on CV outcomes are discussed.

Assessing the impact of a targeted electronic medical record intervention on growth factor usage in cancer patients.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 262-262
Author(s):  
Jordan Bernens ◽  
Kara Hartman ◽  
Brendan F. Curley ◽  
Sijin Wen ◽  
Jame Abraham ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Low Risk ◽  
Individual Risk ◽  
Individual Risk Factors ◽  
The Impact

262 Background: Patients receiving chemotherapy are at risk for febrile neutropenia following treatment. The American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) recommend screening patients for risk of febrile neutropenia and risk stratification based on likelihood of febrile neutropenia events. Prophylactic growth factors (G-CSF) should be in patients receiving high-risk regimens or intermediate-risk regimens with individual risk factors. The impact of electronic medical record system (EMR) implementation on compliance with G-CSF support guidelines has not been studied. Methods: At West Virginia University/Mary Babb Randolph Cancer Center we conducted an IRB approved retrospective chart review of cancer patients receiving chemotherapy from January 1, 2007 to August 1, 2008 (pre-EMR) and January 1, 2011 to December 31, 2011 (post-EMR). We reviewed the chemotherapy regimens and patient risk factors for developing febrile neutropenia, and determined if the G-CSF usage was consistent with guideline recommendations. Results: Compliance with prophylactic G-CSF guidelines was 75.6% in the post-EMR arm, compared to 67.5% in the pre-EMR arm (p=0.041, ch-square). The post EMR data of 1,042 new chemotherapy initiations showed: (see Table). The appropriateness of usage in high and low risk patients were the most compliant, as G-CSF orders were built into chemotherapy plans of high risk regimens and omitted from low risk regimens. Conclusions: Appropriate prophylactic G-CSF usage can be improved when orders are integrated into standard chemotherapy order sets in an EMR. An area of further improvement would include automatic identification of individual risk factors by the EMR. [Table: see text]

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