ORIGINAL ARTICLEOutcomes of Patients With Stable Heart Failure Undergoing Elective Noncardiac Surgery
Section snippets
PATIENTS AND METHODS
Preoperative evaluation at the Internal Medicine Preoperative Assessment Consultation and Treatment (IMPACT) Center at the Cleveland Clinic involves a complete history and physical examination, detailed risk assessment and perioperative risk stratification, and clinical management by a hospitalist. If signs of decompensated HF are apparent during the evaluation, therapies are initiated to optimize volume status, and, if appropriate, cardiac status is reevaluated (with echocardiography, stress
RESULTS
A total of 596 potentially eligible patients with HF were identified who were monitored for a median of 1.9 years after surgery. Thirty-nine patients (6.5%) were excluded because they had no LV imaging studies to document EF. Two more patients were excluded because of severe valvular heart disease. The mean ± SD interval between the cardiac imaging study and the subsequent surgery was 1.8±0.44 years. Finally, a total of 557 patients with HF (192 with EF ≤40% and 365 with EF >40%) and 10,583
DISCUSSION
Our data suggest that perioperative mortality is surprisingly low (<2%) in patients with clinically stable HF—regardless of EF—undergoing elective noncardiac surgery. At 1 year, crude mortality rates for patients with HF with reduced EF (13.5%) or with preserved EF (6.3%) were significantly higher than for controls (3.1%). However, we found no evidence to suggest that the immediate postoperative period was associated with a significantly higher risk of death than the subsequent months. This
CONCLUSION
Our data suggest that patients with clinically stable HF undergoing elective major noncardiac surgery—regardless of EF—can have low perioperative mortality rates, but they are more likely than patients without HF to have longer hospital stays, require hospital readmission, and have a substantial long-term mortality rate.
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Dr Phillips is supported by a Supplement 3 R01 HL080228-01S1 from the National Heart, Lung and Blood Institute of the National Institutes of Health, Bethesda, MD.