To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Eldery With Heart Failure at Higher Risk Following Noncardiac Surgery URL: http://www.pslgroup.com/dg/21EC62.htm Doctor's Guide March 25, 2008
NEW YORK -- March 25, 2008 -- In the largest study of its kind in the United States, researchers from Duke University, Durham, North Carolina, 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, MD, Department of Medicine, Division of Cardiology, Duke University, said that 3 concurrent trends in the next 10 to 20 years point to a need for evaluation of outcomes after noncardiac procedures among patients with heart failure: an elderly population increase of 50%, an increased number of surgical procedures in this population, and an increasing prevalence of heart failure in the general population.
Dr. Hernandez and colleagues reported in the April 2008 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.
"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 from 5% to 12%. Dr. Hernandez's study showed an almost 20% prevalence of heart failure in the elderly undergoing common surgical procedures.
The study looked at 159,327 patients undergoing major noncardiac surgery from 2000 to 2004. Patients were then divided into 3 groups: those with heart failure with or without coronary artery disease (CAD), those with CAD only, and those without either heart failure or CAD. The researchers then observed mortality rates and 30-day readmission rates of the patients.
"We observed a 63% greater risk of operative mortality and a 51% greater risk of 30-day readmission among patients with heart failure compared with 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, anaesthesiologists should find the results of this study especially useful.
Although professional guidelines have provided uniform, evidence-based approaches to the care of patients undergoing major noncardiac procedures, improvements in the care of patients with heart failure in this setting are greatly needed, said Dr. Hernandez.
"Anaesthesiologists 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."
SOURCE: American Society of Anesthesiologists (ASA), Park Ridge, Illinois --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.