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Heart failure makes surgery more risky, even without symptoms



Even relatively healthy heart failure patients can still die after the surgery than those with stronger hearts.

In patients with heart failure with obvious symptoms, surgery has long been associated with a greater risk of complications and death. But the present study suggests new evidence that even patients with heart failure without symptoms have an increased risk of mortality, said senior author of the study, Dr. Sheri Rehn, System.

Researchers analyzed 90-day surgical mortality rates for nearly 48,000 heart failure patients and nearly 562,000 heart failure patients. None of them had urgent surgery or cardiac surgery.

During the study, 2635 heart failure patients, or 5.5%, died within 90 days of surgery, as well as 6,881 patients without heart failure or 1.2%.

Patients with symptomatic heart failure were twice as likely to die as people without heart failure, the study found. Patients with asymptomatic heart failure are still 53% more likely to die.

"All surgery decisions are related to risk and profit compensation, and in many cases benefits still outweigh the risks and the operation should continue," Wren said by email.

While doctors and patients already have to discuss risks and benefits, current research results should help make these conversations more nuanced, especially for patients with asymptomatic heart failure, Wren said.

Heart failure occurs when the heart muscle is too weak to pump enough blood through the body. Symptoms can include fatigue, weight gain from fluid retention, shortness of breath, cough or wheezing.

Patients with heart failure can also develop what is known as reduced left ventricular ejection fraction or reduced ability of the main pump chamber of the heart to push the oxidized blood from the heart to the rest of the body.

In the study, even patients with heart failure without symptoms and a normal ejection fraction were still 46% more likely to die after the surgery than people without heart failure.

Patients with heart failure are more likely to be male, obese, white and older – on average 69 years compared to 59 in people without heart failure. They also tend to have more complex chronic health problems than people without heart failure.

Patients with heart failure are also undergoing more complicated operations than people without heart failure.

One of the limitations of the study, published in JAMA, is that long-term survival rates may be different from the 90-day results surveyed in the study.

However, the results confirm that all patients with heart failure should be cautious about approaching a planned surgery and assure that they manage their disease as long as possible before their operations, said Dr. Amrut Ambardekar, University Cardiology Researcher in Colorado Campus, Aurora, who did not participate in the study.

"Patients with heart failure can be treated to (stabilize) their symptoms; however, this balance can easily be tilted by the stress of the operation, "said Ambardekar by email.

"Elective surgery can make the body more sore for anesthesia, fluid administration, surgical bleeding and / or add new drugs, and these stressors can destabilize a patient with heart failure even if his symptoms are well controlled before surgery."

In some cases, patients with heart failure with symptoms or with reduced pumping capacity may want to postpone surgery, said Dr. Claire Acema of the University of Toronto and the Sunnybrook Research Institute.

"If the surgery can be postponed, then there may be time to stabilize heart failure with drugs (and therefore reduce the risk of the equation)," Atzema, who was not involved in the study, said by email. Patients who want to get the surgery quickly need to know this.

Source: bit.ly/2IaB4Fs JAMA, online February 12, 2019

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