Links Found Between Heart Failure and Post-Surgical Complications

A new study has identified that elderly patients suffering from heart failure (HF) have an increased risk for complications following general surgery.

Researchers from Duke University (Durham, NC, USA) looked at 159,327 patients aged 65 and older who underwent one of 13 major non-cardiac surgery procedures between 2000 and 2004, excluding patients with end-stage renal disease. Patients were then divided into three groups: those with HF with or without coronary artery disease (CAD); CAD only; and those without either HF or CAD. Main outcome measures were operative mortality and 30-day all-cause readmission.

The results showed that of the procedures performed, 18% were performed in patients with heart failure and 34% were performed in patients with CAD. Adjusted hazard ratios of mortality and readmission for patients with HF, compared with patients with neither HF nor CAD, were 1.63 and 1.51, respectively. Adjusted hazard ratios of mortality and readmission for patients with CAD, compared with patients with neither HF nor CAD, were 1.08 and 1.16, respectively. These results demonstrate that patients with HF were at significantly higher risk for both outcomes compared with patients with CAD. The researchers added that that three concurrent trends in the next 10 to 20 years point to a need for evaluation of outcomes after non-cardiac procedures among patients with heart failure: An elderly population increase of 50%, an increased number of surgical procedures in this population, and increasing prevalence of HF in the general population. The study was published in the April 2008 issue of Anesthesiology.

"We observed a 63% greater risk of operative mortality and a 51% greater risk of 30-day readmission among patients with heart failure compared to patients without heart failure or CAD,” said lead author Adrian F. Hernandez, M.D. "To put the risk due to heart failure in context, only emergent or urgent surgeries were more important than heart failure for predicting death. Furthermore, heart failure was the most important factor for predicting readmission.”

"Anesthesiologists and other physicians should ensure that patients with heart failure are as stable as possible with minimal symptoms and are on optimal medications before surgery,” added Dr. Hernandez. "In addition, physicians should pay close attention to patients' early postoperative care as well as establish early follow-up after discharge to identify signs or symptoms of worsening heart failure as early as possible.”


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