A survey of methods used for cardiac risk assessment prior to major vascular surgery.

OBJECTIVES To assess the frequency with which various methods of cardiac risk assessment are used prior to major vascular surgery and the way in which patients considered to the "high" risk are managed. DESIGN Questionnaire survey. SETTING Great Britain and Northern Ireland. MATERIALS Vascular Surgeons who are current members of the Vascular Surgical Society of Great Britain and Northern Ireland. CHIEF OUTCOME MEASURES Number of respondents reporting routine or frequent use of particular investigations and methods of management. MAIN RESULTS Of 246 respondents, 52% had access to a high dependency unit and 77% used intensive therapy units routinely following aortic reconstruction. Some measure of ejection fraction was the most common investigation and was used routinely prior to aortic reconstruction by 35% and often by 33% of respondents, this being more frequent in respondents from teaching hospitals and those carrying out a greater number of reconstructions. Calculated clinical risk indices were rarely used. The identification of high risk patients led to referral to a cardiologist for 90% of respondents and influenced the choice of anaesthetist for 50%. CONCLUSIONS It is concluded that there is considerable variation in practice, but that those who carry out more vascular surgery are more aggressive in their assessment of cardiac risk prior to reconstruction.