In the England amputation cohort, 3.74% had a myocardial infarction within 90 days of a below-knee amputation - a higher yield than the 6.24% reoperation rate would suggest for where attention should sit. The post-amputation patient is usually followed by the surgical team for the wound and the prosthetic pathway, and the medical risk is assumed to be someone else's remit.
Make it yours. At the first diabetes clinic contact after a major amputation, treat it as a fresh cardiovascular event equivalent: check that a statin and antiplatelet are actually being taken, review blood pressure, and look for the silent presentation that immobility and neuropathy conspire to hide. A patient who cannot walk will not report exertional chest pain.
- Confirm statin and antiplatelet are prescribed and being taken, not just listed.
- Ask about breathlessness and fatigue rather than exertional chest pain in someone who is not mobilising.
- Review blood pressure and renal function within the 90-day window.
- Do not assume the surgical team has covered medical secondary prevention.
- Book the contralateral foot check into the same appointment so it is not deferred.
Why it matters
Medical risk in the months after amputation falls between the surgical and diabetes teams, and neither reliably picks it up.
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