Perioperative Considerations for Heart Failure

In the elderly population, the most predominant etiology for hospitalization is heart failure (HF). The possibility of developing intraoperative and postoperative complications increases in patients with de novo HF or those who decompensate suddenly. Among the many classification systems described for HF, the 2013 American College of Cardiology Foundation/American Heart Association classification is the most commonly used. In this classification system, in accordance with the ejection fraction (EF), the HF is categorized into two types: First, those with reduced (≤40%) EF or systolic heart failure and second, those with preserved (≥50%) EF or diastolic heart failure. Plasma natriuretic peptide measurement and echocardiography constitute the diagnostic modalities of choice. Management of HF centers around a combination of diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, arginine receptor neprilysin inhibitors, and sodium-glucose cotransporter-2 inhibitors. The emergence of newer, innovative therapies that are effective and well-tolerated, can potentially improve the outcomes of these patients. Perioperative risk assessment involves the awareness of the etiology of HF, the magnitude of symptoms of HF, concomitant cardiac or non-cardiac risk factors for morbidity/mortality, and the urgency and type of surgery. The review discusses the pharmacological, non-pharmacological, and perioperative management of HF.