title: The management of patients with ischaemic heart disease undergoing non-cardiac elective surgery: a survey of Australian and New Zealand clinical practice.
abstract: Improvements in patient risk stratification and peri-operative beta-blockade have been suggested as methods which can reduce cardiovascular risk in patients with known cardiac risk factors. A postal questionnaire was sent to all Australian and New Zealand teaching hospitals to identify patterns of pre-operative cardiac risk evaluation and methods of peri-operative beta-blocker use. In all, 67 replies were evaluated (64% response rate). Specialist anaesthetists are present in the majority of pre-admission clinics (78%), with a designated peri-operative physician in 9%. Further cardiological referral was possible in almost all institutions (96%), and specific peri-operative physician referral in 54%. Waiting times for specialist consultation were < 7 days in the majority of cases. Whilst 79% of institutions used peri-operative beta-blockade, specific protocols were available in only 10%. In 60% of institutions, beta-blockers were administered to high-risk patients, and in 25% they were given to intermediate risk group patients. There was a wide range in the duration of pre- and postoperative beta-blocker administration. Whilst peri-operative risk assessment appears to be consistent, the pattern of beta-blockade, a known beneficial intervention, is variable. Reasons need to be identified, protocols developed and consistent administration targeted for further improvements to be made.
authors.affiliation: Department of Anaesthesiology and Perioperative Medicine, North Shore Hospital, Shakespeare Road, Auckland, New Zealand. darcy.price@waitematadhb.govt.nz
authors.forename: D J
authors.initials: DJ
authors.lastname: Price
authors.forename: M T
authors.initials: MT
authors.lastname: Kluger
authors.forename: T
authors.initials: T
authors.lastname: Fletcher
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D001315:Australia; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D019538:Health Care Surveys; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control; D017202:Myocardial Ischemia / Q000150:complications / Q000628:therapy*; D009520:New Zealand; D018579:Patient Selection; D019990:Perioperative Care / Q000379:methods*; D011364:Professional Practice / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000592:standards; D018570:Risk Assessment / Q000379:methods
chemical_list: D000319:Adrenergic beta-Antagonists