For at-risk patients, a new FDA label spells out how anesthesiologists should assess how much trouble they could have during surgery

If you have a medical condition or a risk factor that could put you at greater risk for a heart attack, read on. Anesthesiologists say your doctor can tell if you’re at risk from…

For at-risk patients, a new FDA label spells out how anesthesiologists should assess how much trouble they could have during surgery

If you have a medical condition or a risk factor that could put you at greater risk for a heart attack, read on. Anesthesiologists say your doctor can tell if you’re at risk from a standard initial evaluation.

The FDA has issued a new regulatory label for two potentially lifesaving medications that are not required to be on the market to induce patients to take heart-saving drugs in major surgeries and beyond. The drugs, marketed by Amgen Inc. and AstraZeneca PLC, are commonly given as a last resort to patients that are resistant to defibrillators that can act quickly to stabilize irregular heartbeats.

The new label specifies that in cases where patients have been certified to receive an as-needed defibrillator and don’t have one yet, anesthesiologists should evaluate the patients before they get their surgery to determine if they still need an additional treatment, usually an additional cardiac arrest-preventing drug known as tPA. These medications can require four or five doses, the anesthesiologists say. The new label indicates that “as-needed” carries a corresponding “as needed” word on the label that reads, “Because defibrillators and tPA are often not available for patients in imminent need of treatment.”

“The fact that most of these drugs aren’t required” on the market gives anesthesiologists more room to intervene, said Dr. Scott McNeely, an anesthesiologist at UCLA and a spokesman for the American Society of Anesthesiologists.

The new labeling also describes how hospital anesthesia departments should ask patients if they have a health condition that could affect their safety or ability to undergo surgery. This is done both to recognize health issues that could provoke a heart attack and “to alert the anesthesiologist in advance if the patient is at risk for a heart attack,” according to the FDA.

The American College of Surgeons recommends that every inpatient surgery patient should be screened for health concerns before undergoing surgery.

“Immediate access to quality electronic health records is crucial in maintaining a patient’s health record and identifying health concerns that might affect their procedure,” said Dr. Suzanne McCarron, the president of the College of Surgeons.

But more advanced electronic health records systems are still in the pipeline.

“In terms of blood coagulation, the vast majority of patients do well,” said Dr. Greg Wilkinson, director of cardiovascular intensive care at Bellevue Hospital Center in New York and a spokesman for the American Society of Anesthesiologists. He added that it’s even more challenging to gauge blood coagulation for patients with heart attacks or who have had a stroke.

Surgeons typically learn in advance about the probability of cardiac problems they’re going to treat on the operating table and are likely to notice in the years leading up to surgery, the anesthesiologists said.

“Dr. Neil Ma said it’s important to ask the patient about any known medical history because of the nuances of a people-around-their-heart event,” McNeely said.

Ma is a cardiologist at Cedars-Sinai Medical Center in Los Angeles.

According to the American Heart Association, heart attacks happen more frequently when a patient is overweight, sedentary and doesn’t engage in other healthy habits, and tend to occur most often in middle-aged people.

For people who have gone through heart bypass surgery, cardiologists advise that certain lifestyle changes will not only help with long-term cardiac health but also improve patient outcomes in the wake of major surgeries, such as that for aortic valve replacements. People undergoing these procedures can expect to gain up to 20 pounds, gain muscle mass and also lose “body fat as well as any muscle mass if they are not eating their diet, but they can also exercise,” McCarron said.

“Given that the recommended recommendations are: Go for brisk walking six days a week, work out 10 to 15 minutes a day, diet an appropriate amount, and avoid high fat and high sugar foods,” McNeely said, “going out for one or two runs per week is quite sufficient.”

Excerpted from “Risk Factor: The New Science of Avoiding Heart Attacks and Fasting Death,” written by Melissa Meyer.

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