Preoperative Heart Failure Treatment Prevents Postoperative Cardiac Complications in Patients With Lower Risk: A Retrospective Cohort Study.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 Jan 2023
01 Jan 2023
Historique:
pubmed:
4
2
2021
medline:
3
3
2023
entrez:
3
2
2021
Statut:
ppublish
Résumé
The objective of this study was to identify undertreated subgroups of patients with heart failure who would benefit from better perioperative optimization. Patients with heart failure have increased risks of postoperative cardiac complications after noncardiac surgery. In 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. History 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. In 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.
Sections du résumé
OBJECTIVE
OBJECTIVE
The objective of this study was to identify undertreated subgroups of patients with heart failure who would benefit from better perioperative optimization.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Patients with heart failure have increased risks of postoperative cardiac complications after noncardiac surgery.
METHODS
METHODS
In 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.
RESULTS
RESULTS
History 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.
CONCLUSIONS
CONCLUSIONS
In 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.
Identifiants
pubmed: 33534230
doi: 10.1097/SLA.0000000000004779
pii: 00000658-900000000-93731
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e33-e39Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Devereaux PJ, Sessler DI. Cardiac complications in patients undergoing major noncardiac surgery. N Engl J Med. 2015;373:2258–2269.
Smilowitz NR, Gupta N, Ramakrishna H, et al. Perioperative major adverse cardiovascular and cerebrovascular events associated with noncardiac surgery. JAMA Cardiol. 2017;2:181–187.
Lerman BJ, Popat RA, Assimes TL, et al. Association of left ventricular ejection fraction and symptoms with mortality after elective noncardiac surgery among patients with heart failure. JAMA. 2019;321:572–579.
Huang YY, Chen L, Wright JD. Comparison of perioperative outcomes in heart failure patients with reduced versus preserved ejection fraction after noncardiac surgery. Ann Surg. 2022;275:807–815.
Lerman BJ, Popat RA, Assimes TL, et al. Association between heart failure and postoperative mortality among patients undergoing ambulatory noncardiac surgery. JAMA Surg. 2019;154:907–914.
Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014;64:e77–e137.
Kristensen SD, Knuuti J, Saraste A, et al. 2014ESC/ESA guidelines on noncardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35:2383–2431.
Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–1049.
Leeds IL, Canner JK, Gani F, et al. Increased healthcare utilization for medical comorbidities prior to surgery improves postoperative outcomes. Ann Surg. 2020;271:114–121.
American Society of Anesthesiologists. ASA Physical Status Classification System. Accessed March 13, 2019
Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4:e297.
Ng PY, Ng AK, Subramaniam B, et al. Association of preoperatively diagnosed patent foramen ovale with perioperative ischemic stroke. JAMA. 2018;319:452–462.
Friedrich S, Ng PY, Platzbecker K, et al. Patent foramen ovale and long-term risk of ischaemic stroke after surgery. Eur Heart J. 2019;40:914–924.
Williams B, Mancia G, Spiering W, et al. 2018ESC/ESH guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953–2041.
American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S13–S28.
Hernandez AF, Whellan DJ, Stroud S, et al. Outcomes in heart failure patients after major noncardiac surgery. J Am Coll Cardiol. 2004;44:1446–1453.
Hammill BG, Curtis LH, Bennett-Guerrero E, et al. Impact of heart failure on patients undergoing major noncardiac surgery. Anesthesiology. 2008;108: 559–567.
Charlson ME, MacKenzie CR, Gold JP, et al. Risk for postoperative congestive heart failure. Surg Gynecol Obstet. 1991;172:95–104.
Gupta PK, Gupta H, Sundaram A, et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011;124:381–387.
Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:2215–2245.
Wijeysundera DN, Duncan D, Nkonde-Price C, et al. Perioperative beta blockade in noncardiac surgery: a systematic review for the 2014ACC/ AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:2246–2264.
Rodseth RN, Lurati Buse GA, Bolliger D, et al. The predictive ability of preoperative B-type natriuretic peptide in vascular patients for major adverse cardiac events: an individual patient data meta-analysis. J Am Coll Cardiol. 2011;58:522–529.
Schwalm JD, Ivers NM, Natarajan MK, et al. Cluster randomized controlled trial of delayed educational reminders for long-term medication adherence in ST-elevation myocardial infarction (DERLA-STEMI). Am Heart J. 2015;170:903–913.
Luscher TF. Personalized approaches to heart failure: age, acute presentation, and comorbidities. Eur Heart J. 2018;39:4223–4226.