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Heart failure is a significant risk factor in patients undergoing non cardiac surgery

Posted Oct 05 2009 10:03pm

Hammill and colleagues (Anesthesiology 2008;108:599 – 67) compared operative mortality and 30 day readmission for 159,327 Medicare patients undergoing non cardiac procedures.   Heart failure (HF) patients constituted 18% of his group, 34% of the patients had coronary artery disease (CAD) and 47% had neither condition (N).   Overall mortality was 8% in the HF group compared to 3.1% in the CAD group and 2.4% in the N group.   Thirty day readmission rates were also significantly higher for the HF group (17.1%) compared to the other two groups (CAD 10.8% and N 8.1%).   Specifically the risk of operative mortality was 63% greater in HF patients than in patients without HF or CAD.   The authors note that most of the anesthesia guidelines for patients with heart disease focus on coronary artery disease, yet 20% of the elderly present for common surgical procedures had heart failure.   There findings for HF prevalence are at variance with prior studies suggesting that HF was present in about 5 – 12% of the general surgical population.   The authors felt that this may be due to the small sample size of many of these earlier studies.   This study has demonstrated that patients with HF have substantially greater risk of death and 30 day readmission and the authors call for more studies to develop optimal management for this group of patients.

 

David S. Smith, M.D., Ph.D.

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