TY - JOUR
T1 - Preoperative Heart Failure Treatment Prevents Postoperative Cardiac Complications in Patients with Lower Risk
T2 - A Retrospective Cohort Study
AU - Shay, Denys
AU - Ng, Pauline Y.
AU - Dudzinski, David M.
AU - Grabitz, Stephanie D.
AU - Mitchell, John D.
AU - Xu, Xinling
AU - Houle, Timothy T.
AU - Bhatt, Deepak L.
AU - Eikermann, Matthias
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - 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: Patients with heart failure have increased risks of postoperative cardiac complications after noncardiac surgery. 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: 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: 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.
AB - 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: Patients with heart failure have increased risks of postoperative cardiac complications after noncardiac surgery. 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: 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: 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.
KW - cardiovascular complications
KW - heart failure
KW - perioperative treatment
UR - http://www.scopus.com/inward/record.url?scp=85136108868&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000004779
DO - 10.1097/SLA.0000000000004779
M3 - Article
C2 - 33534230
AN - SCOPUS:85136108868
SN - 0003-4932
VL - 277
SP - E33-E39
JO - Annals of Surgery
JF - Annals of Surgery
IS - 1
ER -