Cardiac Optimisation in Proximal Femoral Fractures in the Elderly

Fragility hip fractures are increasingly common in elderly patients and are associated with high morbidity and mortality. Cardiovascular comorbidities-including ischaemic heart disease, heart failure, and valvular disease-contribute significantly to poor outcomes. This study aimed to review perioperative cardiac complications in elderly patients undergoing fragility hip fracture repair and evaluate strategies for optimisation, with emphasis on postoperative atrial fibrillation (POAF), acute myocardial infarction (AMI), heart failure, and management of cardiac implantable electronic devices (CIEDs). We conducted a narrative review drawing data from the databases PubMed, Embase, and the Cochrane Library (January 2000-March 2024). The search terms included "hip fracture," "cardiac complications," "postoperative atrial fibrillation," "myocardial infarction," "heart failure," "valvular disease," and "cardiac implantable electronic devices." Guidelines from the National Institute for Health and Care Excellence (NICE), the European Society of Cardiology (ESC), and the American College of Cardiology/American Heart Association (ACC/AHA) were also reviewed. POAF was observed in ~3-4% of elderly hip fracture patients and is associated with significantly higher one-year mortality (60% vs. 19.5%). Risk factors include surgical delay beyond 48 hours and transfusion of >2 units of packed red blood cells. AMI and perioperative heart failure are frequently underdiagnosed due to atypical presentations. CIED management requires multidisciplinary coordination to avoid device malfunction. Cardiac optimisation in fragility hip fracture patients remains challenging due to heterogeneous evidence and variable practice. Development of validated POAF risk prediction tools, standardised treatment protocols, and structured multidisciplinary pathways may help improve outcomes and reduce healthcare burden.