Validation of Heart Rate Recovery as a Peri-operative Risk Measure
- Conditions
- Peri-operative Injury
- Registration Number
- NCT05561608
- Lead Sponsor
- University of Glasgow
- Brief Summary
Is heart rate recovery after submaximal exercise (i.e. not to exhaustion) a valid risk measure for post-operative outcomes?
- Detailed Description
There are approximately 1.5 million major operations carried out in the NHS every year. As the population ages, and surgical technique becomes more advanced, more patients are undergoing operations which carry a high risk of complications. Currently, doctors predict this risk by asking patients about medical problems and their level of physical fitness. If an operation is very high risk, a patient may undergo cardiopulmonary exercise testing (CPET) where the patient rides an exercise bike to maximum effort (exhaustion) whilst their heart and lung function is measured. This gives the doctor specific numbers which can be discussed with the patient about the risk of complications after surgery. However, CPET is expensive and not all patients are able to do it, for example due to joint or circulation problems. Patients can also find attempting to reach maximal effort demanding and uncomfortable.
Heart rate recovery (HRR) after maximal exercise has been shown to indicate post-operative risk of complications, and is also related to life-expectancy in people with heart failure. The utility of HRR after submaximal exercise however has not been investigated as extensively. One group demonstrated that submaximal HRR predicts post-operative complications after lung surgery, and submaximal HRR also predicts life-expectancy in healthy individuals. There is less information about submaximal HRR as the methods of measuring it are not standardised. Previous work by our group has confirmed the reproducibility of submaximal HRR in a healthy population, and demonstrated different ways in which to measure it. We believe that submaximal HRR provides a "middle-ground" method of assessing how fit a patient is for surgery.
With informed consent, 95 patients across four hospitals in the West of Scotland will perform a step test pre-operatively. The step test will involve non-invasive measurement of the heart rate. Patients will exercise until approximately two-thirds of their predicted maximum heart rate is reached and then recover sitting, whilst the rate of their heart rate recovery is recorded. Patients will have pre- and post-operative troponin values measured (blood marker of strain/injury to the heart). Alongside the blood tests, patients will also answer questionnaires related to their quality of life, and information regarding other post-operative complications will be recorded.
Our study aims to demonstrate that submaximal HRR is predictive of post-operative myocardial injury (stress/injury to the heart wall due to the body's response to the operation) and that is it a valid measure when compared to the scores, blood tests and exercise tests that are currently in use in the NHS. In the future, submaximal exercise testing with HRR measurement may be offered to patients unable to perform CPET and will guide shared decision-making between patient, surgeon and anaesthetist to ensure the best outcome for the patient regarding their surgical options.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 95
- Provision of informed consent
- Age 50 years or over
- Able to walk unaided
- Planned elective intermediate/high risk surgery as defined by the ESC/ESA guidelines (i.e. >1% risk of mortality)
- Pregnancy
- Ongoing participation in any investigational research which could undermine the scientific basis of the study
- Presence of any of the American Thoracic Society's contraindications to exercise testing
- Previous intermediate/high risk surgery within three months prior to recruitment
- Previous participation in the VERVE study at any time
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Post-operative myocardial injury 48 hours post-operatively Post-operative troponin over the 99th centile upper reference limit plus a 20% change (increase or decrease)
- Secondary Outcome Measures
Name Time Method Major adverse kidney events 30 days post-operatively Composite of renal mortality, renal replacement therapy, over 30% decline in eGFR from baseline
EQ-5D-5L 30 days and 1 year post-operatively Patient reported quality of life score
Length of hospital stay (with/without hospital mortality) Up to 1 year post-operatively Acute Kidney Injury 1 week post-operatively As defined by KDIGO consensus
Cardiovascular complications 7 days post-operatively Incidence of myocardial infarction, cardiac death, non-fatal cardiac arrest, coronary revascularisation, pulmonary embolus, deep-veined thrombosis, or new onset atrial fibrillation
Major adverse cardiac events 30 days post-operatively Composite of cardiac death, myocardial infarction, non-fatal cardiac arrest, and coronary revascularisation
Mortality Day 30, day 90 and 1 year post-operatively Infective complications 7 days post-operatively Presence of fever \<38.5 and clinical suspicion of infection
Neurological complications 7 days post-operatively Delirium or stroke
Pulmonary complications 7 days post-operatively Atelectasis, pneumonia, acute respiratory distress syndrome or pulmonary aspiration
Days alive and out of hospital 30 days post-operatively Readmission to hospital Within 30 days post-operatively Quality of recovery scale - 15 2 days post-operatively Admission/re-admission to Intensive Care 14 days post-operatively
Trial Locations
- Locations (4)
Golden Jubilee National Hospital
🇬🇧Clydebank, United Kingdom
University Hospital, Crosshouse
🇬🇧Kilmarnock, United Kingdom
University Hospital Hairmyres
🇬🇧East Kilbride, United Kingdom
Queen Elizabeth University Hospital
🇬🇧Glasgow, United Kingdom