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The high-risk patient is a much talked about entity in intensive care circles, but identification of these patients still consumes an abundance of research material. The search continues for that elusive symptom, sign or investigation which has a high sensitivity and specificity. Several of the paper reports over the last couple of months have focused on ways to predict mortality in those patients considered to be high risk. Cole et al looked at heart rate recovery following maximum treadmill stress testing in patients referred for this investigation and therefore presumably presenting with cardiac symptoms and signs. They found that this relatively simple and non-invasive investigation predicted a worse outcome if the heart rate failed to decline rapidly after exercise. Mortality at 6 years was 19% compared to 5% in those patients with a normal heart rate recovery. Perhaps this investigation may help us perioperatively identify those at high risk of cardiac events.

Paper reports overview: Mortality and morbidity prediction and reduction in the high risk patient