Christopher C Cheung1, Alan Martyn1, Norman Campbell2, Shaun Frost3, Kenneth Gilbert4, Franklin Michota5, Douglas Seal6, William Ghali7, Nadia A Khan8. 1. Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 2. Department of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada. 3. Department of Medicine, University of Minnesota and HealthPartners, Minneapolis. 4. Department of Medicine, Western University, London, Ontario, Canada. 5. Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio. 6. Department of Anesthesia, University of Calgary, Calgary, Alberta, Canada. 7. Department of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 8. Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: nakhanubc@gmail.com.
Abstract
BACKGROUND: Perioperative hypotension and bradycardia in the surgical patient are associated with adverse outcomes, including stroke. We developed and evaluated a new preoperative risk model in predicting intraoperative hypotension or bradycardia in patients undergoing elective noncardiac surgery. METHODS: Prospective data were collected in 193 patients undergoing elective, noncardiac surgery. Intraoperative hypotension was defined as systolic blood pressure <90 mm Hg for >5 minutes or a 35% decrease in the mean arterial blood pressure. Intraoperative bradycardia was defined as a heart rate of <60 beats/min for >5 minutes. A logistic regression model was developed for predicting intraoperative hypotension or bradycardia with bootstrap validation. Model performance was assessed using area under the receiver operating curves and Hosmer-Lemeshow tests. RESULTS: A total of 127 patients developed hypotension or bradycardia. The average age of participants was 67.6 ± 11.3 years, and 59.1% underwent major surgery. A final 5-item score was developed, including preoperative Heart rate (<60 beats/min), preoperative hypotension (<110/60 mm Hg), Elderly age (>65 years), preoperative renin-Angiotensin blockade (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or beta-blockers), Revised cardiac risk index (≥3 points), and Type of surgery (major surgery), entitled the "HEART" score. The HEART score was moderately predictive of intraoperative bradycardia or hypotension (odds ratio, 2.51; 95% confidence interval, 1.79-3.53; C-statistic, 0.75). Maximum points on the HEART score were associated with an increased likelihood ratio for intraoperative bradycardia or hypotension (likelihood ratio, +3.64). CONCLUSIONS: The 5-point HEART score was predictive of intraoperative hypotension or bradycardia. These findings suggest a role for using the HEART score to better risk-stratify patients preoperatively and may help guide decisions on perioperative management of blood pressure and heart rate-lowering medications and anesthetic agents.
BACKGROUND: Perioperative hypotension and bradycardia in the surgical patient are associated with adverse outcomes, including stroke. We developed and evaluated a new preoperative risk model in predicting intraoperative hypotension or bradycardia in patients undergoing elective noncardiac surgery. METHODS: Prospective data were collected in 193 patients undergoing elective, noncardiac surgery. Intraoperative hypotension was defined as systolic blood pressure <90 mm Hg for >5 minutes or a 35% decrease in the mean arterial blood pressure. Intraoperative bradycardia was defined as a heart rate of <60 beats/min for >5 minutes. A logistic regression model was developed for predicting intraoperative hypotension or bradycardia with bootstrap validation. Model performance was assessed using area under the receiver operating curves and Hosmer-Lemeshow tests. RESULTS: A total of 127 patients developed hypotension or bradycardia. The average age of participants was 67.6 ± 11.3 years, and 59.1% underwent major surgery. A final 5-item score was developed, including preoperative Heart rate (<60 beats/min), preoperative hypotension (<110/60 mm Hg), Elderly age (>65 years), preoperative renin-Angiotensin blockade (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or beta-blockers), Revised cardiac risk index (≥3 points), and Type of surgery (major surgery), entitled the "HEART" score. The HEART score was moderately predictive of intraoperative bradycardia or hypotension (odds ratio, 2.51; 95% confidence interval, 1.79-3.53; C-statistic, 0.75). Maximum points on the HEART score were associated with an increased likelihood ratio for intraoperative bradycardia or hypotension (likelihood ratio, +3.64). CONCLUSIONS: The 5-point HEART score was predictive of intraoperative hypotension or bradycardia. These findings suggest a role for using the HEART score to better risk-stratify patients preoperatively and may help guide decisions on perioperative management of blood pressure and heart rate-lowering medications and anesthetic agents.
Authors: James D Douketis; Alex C Spyropoulos; Scott Kaatz; Richard C Becker; Joseph A Caprini; Andrew S Dunn; David A Garcia; Alan Jacobson; Amir K Jaffer; David F Kong; Sam Schulman; Alexander G G Turpie; Vic Hasselblad; Thomas L Ortel Journal: N Engl J Med Date: 2015-06-22 Impact factor: 91.245
Authors: Marije Wijnberge; Bart F Geerts; Liselotte Hol; Nikki Lemmers; Marijn P Mulder; Patrick Berge; Jimmy Schenk; Lotte E Terwindt; Markus W Hollmann; Alexander P Vlaar; Denise P Veelo Journal: JAMA Date: 2020-03-17 Impact factor: 56.272
Authors: M Wijnberge; J Schenk; E Bulle; A P Vlaar; K Maheshwari; M W Hollmann; J M Binnekade; B F Geerts; D P Veelo Journal: BJS Open Date: 2021-01-08