Robert J. Widmer M.D.

Singh, M., J. A. Spertus, S. M. Gharacholou, R. C. Arora, R. J. Widmer, A. Kanwar, R. M. Sanjanwala, G. A. Welle and M. A. Al-Hijji (2020). “Comprehensive Geriatric Assessment in the Management of Older Patients With Cardiovascular Disease.” Mayo Clin Proc 95(6): 1231-1252.

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Cardiovascular disease (CVD) disproportionately affects older adults. It is expected that by 2030, one in five people in the United States will be older than 65 years. Individuals with CVD now live longer due, in part, to current prevention and treatment approaches. Addressing the needs of older individuals requires inclusion and assessment of frailty, multimorbidity, depression, quality of life, and cognition. Despite the conceptual relevance and prognostic importance of these factors, they are seldom formally evaluated in clinical practice. Further, although these constructs coexist with traditional cardiovascular risk factors, their exact prevalence and prognostic impact remain largely unknown. Development of the right decision tools, which include these variables, can facilitate patient-centered care for older adults. These gaps in knowledge hinder optimal care use and underscore the need to rigorously evaluate the optimal constructs for providing care to older adults. In this review, we describe available tools to examine the prognostic role of age-related factors in patients with CVD.

Cullen, M. W., R. B. McCully, R. J. Widmer, D. R. Schroeder, B. R. Salonen, D. Raslau, K. K. Sundsted, A. B. Mohabbat, B. M. Dougan, D. M. Bierle, A. Widmer, D. Banerjee, P. Gaba, R. Tellez, G. C. Kane, P. A. Pellikka and K. F. Mauck (2020). “Preoperative Dobutamine Stress Echocardiography and Clinical Factors for Assessment of Cardiac Risk after Noncardiac Surgery.” J Am Soc Echocardiogr 33(4): 423-432.

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BACKGROUND: The role of dobutamine stress echocardiography (DSE) in the risk stratification of patients undergoing noncardiac surgery in the current era is unclear. The aim of this study was to evaluate the yield of DSE and the additive role of DSE to clinical criteria for preoperative risk stratification of patients undergoing noncardiac surgery. METHODS: The study included 4,494 patients undergoing DSE /=3 had an event rate of 7.5%. The event rates for patients with wall motion score index >/=1.7 at baseline, left ventricular ejection fractions <40% at peak stress, or ischemic thresholds <70% of age-predicted maximal heart rate were 7.1%, 8.6%, and 7.9%, respectively. After adjusting for clinical variables, the overall result of DSE (P < .001), baseline and peak-stress wall motion score index (P < .001 and P = .014, respectively), peak-stress left ventricular ejection fraction (P < .001), and the number of ischemic segments (P = .027) were all associated with postoperative cardiac events. Incremental multivariate analysis demonstrated that an overall abnormal result on DSE, added to clinical variables, was associated with an increased risk for postoperative cardiac events (odds ratio, 2.07; 95% CI, 1.35-3.17; P < .001). CONCLUSIONS: Baseline and peak-stress findings on preoperative DSE add to the prognostic utility of clinical variables for stratifying cardiac risk after noncardiac surgery.