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

According to an American study, even patients with relatively healthy heart failure are more likely to die after surgery than patients with healthier hearts.

For patients with symptomatic heart failure, surgery has long been badociated with a higher risk of complications and death. But the present study offers new evidence that even asymptomatic heart failure carries a risk of increased mortality, said Dr. Sherry Wren, lead author of the study, vice president of surgery at the Faculty of Medicine. Stanford University Medicine and Head of the General Surgery Department of the Palo Alto Veterans Health System.

The researchers badyzed 90-day surgical mortality rates for nearly 48,000 patients with heart failure and nearly 562,000 patients without heart failure. All surgeries were optional; none was heart. During the study, 2,635 people with heart failure, 5.5%, died within 90 days of surgery, as well as 6,881 patients without heart failure, or 1.2%. The study found that patients with symptomatic heart failure were more than twice as likely to die as people without heart failure. Asymptomatic heart failure patients were still 53% more likely to die.

"All surgical decisions involve risk compromises and benefits, and in many cases the benefits outweigh the risks and the surgery should continue," Wren said via email.

While doctors and patients should already discuss the risks and benefits, the results of the current study should help these conversations become more nuanced, especially for patients with asymptomatic heart failure, Wren said.

In the study, even heart failure patients without symptoms and with a normal left ventricular ejection fraction still had 46% more risk of dying after surgery than people without heart failure.

Heart failure patients were more likely to be men, obese, white, and older – an average of 69 years compared to 59 for non-heart failure patients. They also tended to have more complex chronic health problems than people without heart failure. Patients with heart failure also underwent more complex operations than people without heart failure.

A limit of the study, published on February 12 online in JAMAis that long-term survival rates may be different from the 90-day results examined in the study.

Even in this case, the results confirm that all patients with heart failure should be cautious when approaching elective surgery and ensure that they manage their disease as much as possible before their operation. said Dr. Amrut Ambardekar, a cardiology researcher at the University of Colorado, Anschutz Medical. Campus in Aurora, CO, who did not participate in the study.

"Patients with heart failure can be treated to (stabilize) their symptoms, however, this balance can be easily compromised by the stress of a surgical procedure," Ambardekar said by e-mail.

"Elective surgeries can stress the body due to anesthesia, administration of liquids, surgical bleeding and / or the addition of new medications." These stressors can stress the body due to anesthesia, administration of liquids, surgical bleeding and / or the addition of new drugs. may destabilize a patient with heart failure even if his symptoms were well controlled before surgery. "

In some cases, patients with heart failure may want to delay elective surgery, said Dr. Clare Atzema of the University of Toronto and Sunnybrook Research Institute. "If surgery can be postponed, then it may be time to stabilize heart failure with medications (and thus reduce the risk side of the equation)," said Atzema, who n & # 39; 39, did not participate in the study, by e-mail. "Patients who want to have surgery quickly need to know it."

-Lisa Rapaport