• Annals of surgery · Jan 2023

    Preoperative Heart Failure Treatment Prevents Postoperative Cardiac Complications in Patients With Lower Risk: A Retrospective Cohort Study.

    • Denys Shay, Pauline Y Ng, David M Dudzinski, Stephanie D Grabitz, John D Mitchell, Xinling Xu, Timothy T Houle, Deepak L Bhatt, and Matthias Eikermann.
    • Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
    • Ann. Surg. 2023 Jan 1; 277 (1): e33e39e33-e39.

    ObjectiveThe objective of this study was to identify undertreated subgroups of patients with heart failure who would benefit from better perioperative optimization.Summary Of Background DataPatients with heart failure have increased risks of postoperative cardiac complications after noncardiac surgery.MethodsIn this analysis of hospital registry data of 130,677 patients undergoing noncardiac surgery, the exposure was preoperative history of heart failure. The outcome, cardiac complications, was defined as a composite of myocardial infarction, cardiac arrest, acute heart failure, and mortality within 30 postoperative days.ResultsHistory of heart failure (n = 10,256; 7.9%) was associated with increased risk of cardiac complications [8.1% vs 1.1%; adjusted odds ratio, 2.28 (95% CI, 2.02-2.56); P < 0.001). Patients with heart failure and who carried a lower risk profile had increased risks of postoperative cardiac complications secondary to heart failure [adjusted absolute risk difference, 1.7% (95% CI, 1.4%-2.0%, lower risk); P < 0.001 vs 0.5% (95% CI, -0.6% to 1.6%, higher risk); P = 0.38]. Patients with heart failure and lower risk received a lower level of health care utilization preoperatively, and less frequently received anti-heart failure medications (59% vs 72% and 61% vs 82%; both P < 0.001). These preventive therapies significantly decreased the risk of cardiac complications in patients with heart failure.ConclusionsIn patients with heart failure who have a lower preoperative risk profile, clinicians often make insufficient attempts to optimize their clinical condition preoperatively. Preoperative preventive treatment reduces the risk of postoperative cardiac complications in these lower-risk patients with heart failure.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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