A SURVEY OF METHODS USED FOR CARDIAC RISK ASSESSMENT PRIOR TO MAJOR VASCULAR-SURGERY

Objectives: To assess the frequency with which various methods of card iac risk assessment are used prior to major vascular surgery and the w ay in which patients considered to be ''high'' risk are managed. Desig n: Questionnaire survey. Setting: Great Britain and Northern Ireland. Materials: Vascular Surgeons who are current members of the Vascular S urgical Society of Great Britain and Northern Ireland. Chief outcome m easures: Number of respondents reporting routine or frequent use of pa rticular investigations and methods of management. Main results: Of 24 6 respondents, 52% had access to a high dependency unit and 77% used i ntensive therapy units routinely following aortic reconstruction. Some measure of ejection fraction was the most common investigation and wa s used routinely prior to aortic reconstruction by 35% and often by 33 % of respondents, this being move frequent in respondents from teachin g hospitals and those carrying out a greater number of reconstructions . Calculated clinical risk indices were rarely used. The identificatio n of high risk patients led to referral to a cardiologist for 90% of r espondents and influenced the choice of anaesthetist for 50%. Conclusi ons: It is concluded that there is considerable variation in practice, but that those who carry out more vascular surgery are move aggressiv e in their assessment of cardiac risk prior to reconstruction.