An estimated 4.2 million people worldwide die within 30 days of surgery each year. New research published in the European Heart Journal suggests that some of these deaths and serious cardiac complications could be prevented if patients are reviewed by a cardiology specialist as part of their post-operative care.
In this observational study, researchers examined patients who experienced heart damage during or shortly after non-cardiac surgery. While some were assessed by a cardiologist, others were not. Those who received specialist cardiac input were less likely to die within the following year and had a lower risk of developing further serious heart problems, including heart attack, heart failure or abnormal heart rhythms.
With an ageing population, surgery is becoming increasingly common. Even when the operation does not involve the heart, the physiological stress of surgery, including anaesthesia, blood loss, inflammation and fluctuations in blood pressure, can strain the heart and lead to perioperative myocardial infarction or injury (PMI).
In high-risk individuals, such as those with existing cardiovascular disease or those over 65, PMI occurs in around 15% of cases, often without symptoms. Despite this silent presentation, PMI strongly predicts complications and death in the days and months following surgery.
To explore whether closer cardiac involvement might reduce complications and mortality, the researchers took advantage of a ‘natural experiment’, based on whether a cardiologist happened to be available to assess patients.
The study included 14,294 high-risk patients undergoing non-cardiac procedures, such as orthopaedic surgery, at University Hospital Basel or Cantonal Hospital Aarau. All were considered at increased risk of PMI due to age (65 years or older) or pre-existing cardiovascular disease.
After surgery, patients underwent blood testing to measure troponin, a protein released when the heart muscle is damaged. The analysis focused on 1,048 patients whose results indicated heart attack or myocardial injury around the time of their operation and who remained on the surgical ward.
Of these, 614 patients (58.6%) were assessed by a cardiologist, while 434 (41.4%) were not, often because specialists were unavailable at weekends or public holidays, or because more urgent cases were prioritised.
Patients reviewed by a cardiologist were 35% less likely to die within one year of surgery and 46% less likely to experience major adverse cardiac events, including heart attack, acute heart failure, life-threatening arrhythmias or cardiac death. They were also more likely to undergo cardiac imaging and to receive intensive medical therapy.
These findings show that cardiologist involvement after PMI is associated with fewer serious cardiac complications and improved survival at one year. Close collaboration between surgical and cardiology teams may therefore improve outcomes after major operations.
No previous research has investigated this specific intervention with comparable rigour or sample size. However, as this is an observational study, researchers cannot prove causation, even after extensive adjustment. Ultimately, a randomised controlled trial is needed to confirm these results.
Surgery is undertaken only after careful risk assessment, yet complications still arise. Screening high-risk patients for PMI is essential. Where heart injury is detected, cardiologists can provide appropriate monitoring and treatment.
The team is now conducting an implementation study of PMI screening across hospitals in Switzerland and Austria.
Overall, this study provides evidence of clinical benefit and no evidence of harm. It is highly likely that healthcare professionals, systems and, most importantly, patients will favour a structured cardiology consultation following post-operative myocardial injury.
Source: ESC
Image Credit: iStock
