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Top News in Family Medicine February 13, 2019 (7 of 9)

Even relatively healthy heart failure patients can still die after surgery than those with healthy hearts, according to a US study.

In patients with symptomatic heart failure, surgery has long been associated with a greater risk of complications and death. But the current study suggests new evidence that even asymptomatic heart failure carries an increased risk of mortality, said senior author of the study, Dr. Sheri Rehn,

Researchers analyzed 90-day surgical mortality rates for nearly 48,000 heart failure patients and nearly 562,000 heart failure patients. All operations were eligible; no one is hearty. 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 the solutions to the operation are to compromise risk and profit, and in many cases the benefits will 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.

In the study, even patients with symptomatic heart failure and normal left ventricular ejection fraction were still 46% more likely to die after 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 years for 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.

A study limitation published on the internet on February 12th JAMAis 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, CO, who did not participate in the study.

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

"Election operations can affect the body due to anesthesia, fluid administration, surgical bleeding and / or adding new drugs, and these stress factors can destabilize a patient with heart failure even if his symptoms are well controlled before surgery."

In some cases, patients with heart failure 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 their surgery quickly need to know that.

-Lisa Rapporta

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