Validation of a combined comorbidity index.

https://www.medpagetoday.com/upload/2014/3/3/02536-1.pdf

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

Preamble and Transition to ACC/AHA Guidelines to Reduce Cardiovascular Risk S50

The goals of the American College of Cardiology (ACC) and the American Heart Association (AHA) are to prevent cardiovascular diseases (CVD); improve the management of people who have these diseases through professional education and research; and develop guidelines, standards, and policies that promote optimal patient care and cardiovascular health. Toward these objectives, the ACC and AHA have collaborated with the National Heart, Lung, and Blood Institute (NHLBI) and stakeholder and professional organizations to develop …

/pdf/2013-acc-aha-guideline-on-the-assessment-of-cardiovascular-1t8hg65cmz.pdf

2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk

2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Background Cardiac complications are important causes of morbidity after noncardiac surgery. The purpose of this prospective cohort study was to develop and validate an index for risk of cardiac complications. Methods and results We studied 4315 patients aged > or = 50 years undergoing elective major noncardiac procedures in a tertiary-care teaching hospital. The main outcome measures were major cardiac complications. Major cardiac complications occurred in 56 (2%) of 2893 patients assigned to the derivation cohort. Six independent predictors of complications were identified and included in a Revised Cardiac Risk Index: high-risk type of surgery, history of ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, preoperative treatment with insulin, and preoperative serum creatinine >2.0 mg/dL. Rates of major cardiac complication with 0, 1, 2, or > or = 3 of these factors were 0.5%, 1.3%, 4%, and 9%, respectively, in the derivation cohort and 0.4%, 0.9%, 7%, and 11%, respectively, among 1422 patients in the validation cohort. Receiver operating characteristic curve analysis in the validation cohort indicated that the diagnostic performance of the Revised Cardiac Risk Index was superior to other published risk-prediction indexes. Conclusions In stable patients undergoing nonurgent major noncardiac surgery, this index can identify patients at higher risk for complications. This index may be useful for identification of candidates for further risk stratification with noninvasive technologies or other management strategies, as well as low-risk patients in whom additional evaluation is unlikely to be helpful.

/pdf/derivation-and-prospective-validation-of-a-simple-index-for-1o4kxch7qa.pdf

Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery

To determine which preoperative factors might affect the development of cardiac complications after major noncardiac operations, we prospectively studied 1001 patients over 40 years of age. By multivariate discriminant analysis, we identified nine independent significant correlates of life-threatening and fatal cardiac complications: preoperative third heart sound or jugular venous distention; myocardial infarction in the preceding six months; more than five premature ventricular contractions per minute documented at any time before operation; rhythm other than sinus or presence of premature atrial contractions on preoperative electrocardiogram; age over 70 years; intraperitoneal, intrathoracic or aortic operation; emergency operation; important valvular aortic stenosis; and poor general medical condition. Patients could be separated into four classes of significantly different risk. Ten of the 19 postoperative cardiac fatalities occurred in the 18 patients at highest risk. If validated by prospective application, the multifactorial index may allow preoperative estimation of cardiac risk independent of direct surgical risk.

Multifactorial Index of Cardiac Risk in Noncardiac Surgical Procedures

Cardiac risk factors and complications in non-cardiac surgery

MULTIFACTORIAL INDEX OF CARDIAC RISK IN NONCARDIAC SURGICAL PROCEDURES L. Goldman;D. Caldera;S. Nussbaum;F. Southwick;D. Krogstad;B. Murray;D. Burke;T. O'Malley;A. Goroll;C. Caplan;J. Nolan;B. Carabello;E. Slater; Survey of Anesthesiology

Multifactorial index of cardiac risk in noncardiac surgical procedures

THE association of hyperadrenocorticism with cancer has stimulated the curiosity of physicians for many years. Early work by Dobriner1 suggested that the adrenal glands functioned differently both ...

https://www.nejm.org/doi/pdf/10.1056/NEJM196102232640801?listPDF=true

Adrenocortical Hyperfunction in Association with Anaplastic Carcinoma of the Respiratory Tract

For an organ exposed to bacteria from both the systemic and portal circulations, it is surprising that bacterial infections of the liver are so rare. Although viral invasion of hepatic tissue is co...

James P. Nolan

Papers

Multifactorial Index of Cardiac Risk in Noncardiac Surgical Procedures

Cardiac risk factors and complications in non-cardiac surgery

Multifactorial index of cardiac risk in noncardiac surgical procedures

Adrenocortical Hyperfunction in Association with Anaplastic Carcinoma of the Respiratory Tract

Bacteria and the liver.