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Study finds
important links between Heart Failure and
Complications during non-Cardiac Surgery
Newswise — In the
largest study of its kind in the U.S.,
researchers from Duke University have
identified a possible “perfect storm” of
factors pushing heart failure to the
forefront of risks for complications after
surgery in the elderly.
Adrian F. Hernandez,
M.D., said that three concurrent trends in
the next ten to twenty years point to a need
for evaluation of outcomes after non-cardiac
procedures among patients with heart
failure: An elderly population increase of
50 percent, an increased number of surgical
procedures in this population, and
increasing prevalence of heart failure in
the general population.
Dr. Hernandez and
colleagues reported in the April issue of
Anesthesiology that elderly patients with
heart failure who undergo major surgical
procedures have substantially higher risks
of surgical mortality and hospital
readmission than other types of patients –
including those with coronary disease –
admitted for the same procedure.
Heart failure is
defined as a weak heart that causes patients
to have shortness of breath, fatigue or
problems with swelling in their legs.
Finally, until Dr.
Hernandez’s study, data on the effects of
non-cardiac surgery on patients with heart
failure has been hard to come by.
“Professional
guidelines and previous studies have
generally focused on patients undergoing
surgery with a history of heart attacks
rather than congestive heart failure,” said
Dr. Hernandez. “And because of limitations
in previous studies, it is difficult to
fully understand the impact of heart failure
in the perioperative setting.”
Past estimates put
heart failure prevalence in the surgical
population at between 5 to 12 percent. Dr.
Hernandez’s study showed an almost
20-percent prevalence of heart failure in
the elderly undergoing common surgical
procedures.
The study looked at
159,327 patients undergoing major
non-cardiac surgery from 2000-04. Patients
were then divided into three groups: those
with heart failure with or without coronary
artery disease (CAD); coronary artery
disease only and those without either heart
failure or coronary artery disease. The
researchers then observed mortality rates
and 30-day readmission rates of the
patients.
“We observed a
63-percent greater risk of operative
mortality and a 51-percent greater risk of
30-day readmission among patients with heart
failure compared to patients without heart
failure or CAD,” said Dr. Hernandez.
“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. ”
As the physicians most
responsible for maintaining patients’ vital
functions during surgery, the results of
this study are especially useful to
anesthesiologists.
Although professional
guidelines have provided uniform,
evidence-based approaches to the care of
patients undergoing major non-cardiac
procedures, improvements in the care of
patients with heart failure in this setting
are greatly needed, said Dr. Hernandez.
“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,” said 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.”
For more information
visit the Anesthesiology Web site at
http://www.anesthesiology.org.
Founded in 1905, the
American Society of Anesthesiologists is an
educational, research and scientific
association with 43,000 members organized to
raise and maintain the standards of the
medical practice of anesthesiology and
improve the care of the patient..
Visit the ASA Web site
at www.asahq.org.
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