Patient assessment and follow-up: There is no study-specific intervention. The investigators will record data generated by clinical activity before, during and after implementation of the PMI-screening. Follow-up data and the final PMI event adjudication will be the only data generated specifically for this study.
Study summary
The investigators aim to show the feasibility and medicoeconomic impact of implementing a clinical screening and response system for the early detection of perioperative cardiac complications in high-risk patients.
Specifically, the investigators aim to: 1) evaluate the feasibility of implementation of a PMI-screening; 2) evaluate the medicoeconomic impact of implementing a PMI-screening; 3) identify barriers to implementation; 4) generate data for a future randomized controlled trial on outcomes by exploring opportunities to improve care following PMI, the occurrence and timing of major adverse cardiac events (MACE), and the treatment effect associated with PMI-screening.
Eligibility
Sex
ALL
Min age
40 Years
Max age
85 Years
Healthy volunteers
No
Inclusion Criteria:
* Consecutive patients fulfilling the institutional criteria for inclusion into the routine PMI-screening
* aged 40-85 years
* at increased cardiovascular risk
* undergoing inpatient, noncardiac, elective or emergent surgery
* postoperative stay of ≥2 nights at the participating institution
* orthopaedic, traumatology, vascular, spinal, thoracic, neurosurgical, and visceral surgery.
Exclusion Criteria:
* patients with cardiac surgery or interventions in the last 14 days
* chronic renal failure under dialysis, renal transplant surgery
* moderate-to-severe dementia
* previous inclusion within 5 days
* documented refusal to use of their data for research purposes or refusal of further use during follow-up
* Patients declining consent for follow-up will be excluded from follow-up analyses.
Primary outcome measure(s)
Perioperative Myocardial Infarction/Injury (PMI)-Screening (Reach) — during the hospital stay (up to postoperative day 2) Percentage of patients eligible for PMI-screening according to inclusion criteria, but not screened during the implementation phase (defined as no or only one measurement of hs-cTn done during screening days)
Incidence of PMI — after the surgery until postoperative day 2 Percentage of patients experiencing PMI following noncardiac surgery
Cardiology consultation (Fidelity) — during hospital stay (up to postoperative day 5) Percentage of patients with detected PMI by PMI-screening on screening days, seen vs. not seen by a cardiologist
Diagnostic challenge — during hospital stay (up to postoperative day 5) Number of cases with mismatch of initial classification of PMI aetiology (and management pathway) at time of consultation versus final adjudication. In case of two differential diagnoses stated on the cardiology consultation, mismatch is seen when none of the diagnoses correspond to the final adjudication. If three or more differential diagnoses are stated, mismatch is seen in any case even if the final adjudication diagnosis is stated
Barriers to implementation — following the post-implementation period (6 months after implementation) Barriers to implementation will be assessed by a semi-quantitive questionnaire complemented by qualitative focus group including the local investigators and representatives of cardiology and anaesthesiology
Trial sites (5)
Facility
City
Region
Status
University Hospital Innsbruck
Innsbruck
Tyrol
University Hospital Geneva
Geneva
Canton of Geneva
Cantonal Hospital Lucerne
Lucerne
Canton of Lucerne
Canton Hospital Olten
Olten
Canton of Solothurn
Bürgerspital Solothurn
Solothurn
Switzerland
More University Hospital, Basel, Switzerland trials in Switzerland
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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