Key result
Postoperative acute heart failure following non-cardiac surgery was associated with significantly higher 1-year all-cause mortality (44% vs. 11%; aHR 1.7, 95% CI 1.3-2.2; p<0.001).
Why the study?
Although primary acute heart failure is a common cause of hospitalization, the incidence, phenotypes, determinants, and outcomes of acute heart failure developing postoperatively following non-cardiac surgery required assessment.
Does the development of postoperative acute heart failure increase the risk of mortality and readmission in high-risk patients undergoing non-cardiac surgery?
Cohort (n=9,164)
Yes
Does the development of postoperative acute heart failure increase the risk of mortality and readmission in high-risk patients undergoing non-cardiac surgery?
Postoperative acute heart failure occurs in 2.5% of high-risk patients undergoing non-cardiac surgery and is independently associated with significantly increased 1-year mortality and heart failure readmission.
Answers are grounded in this paper and cite their sources.
May warrant closer post-discharge monitoring after non-cardiac surgery; hypothesis-generating for targeted prevention trials.
AIMS: Primary acute heart failure (AHF) is a common cause of hospitalization. AHF may also develop postoperatively (pAHF). The aim of this study was to assess the incidence, phenotypes, determinants and outcomes of pAHF following non-cardiac surgery. METHODS AND RESULTS: A total of 9164 consecutive high-risk patients undergoing 11 262 non-cardiac inpatient surgeries were prospectively included. The incidence, phenotypes, determinants and outcome of pAHF, centrally adjudicated by independent cardiologists, were determined. The incidence of pAHF was 2.5% (95% confidence interval [CI] 2.2-2.8%); 51% of pAHF occurred in patients without known heart failure (de novo pAHF), and 49% in patients with chronic heart failure. Among patients with chronic heart failure, 10% developed pAHF, and among patients without a history of heart failure, 1.5% developed pAHF. Chronic heart failure, diabetes, urgent/emergent surgery, atrial fibrillation, cardiac troponin elevations above the 99th percentile, chronic obstructive pulmonary disease, anaemia, peripheral artery disease, coronary artery disease, and age, were independent predictors of pAHF in the logistic regression model. Patients with pAHF had significantly higher all-cause mortality (44% vs. 11%, p < 0.001) and AHF readmission (15% vs. 2%, p < 0.001) within 1 year than patients without pAHF. After Cox regression analysis, pAHF was an independent predictor of all-cause mortality (adjusted hazard ratio [aHR] 1.7 [95% CI 1.3-2.2]; p < 0.001) and AHF readmission (aHR 2.3 [95% CI 1.5-3.7]; p < 0.001). Findings were confirmed in an external validation cohort using a prospective multicentre cohort of 1250 patients (incidence of pAHF 2.4% [95% CI 1.6-3.3%]). CONCLUSIONS: Postoperative AHF frequently developed following non-cardiac surgery, being de novo in half of cases, and associated with a very high mortality.
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Gualandro et al. (2023) conducted a cohort in High-risk patients undergoing non-cardiac surgery (n=9,164). Postoperative acute heart failure (pAHF) vs. Patients without pAHF was evaluated on 1-year all-cause mortality (aHR 1.7, 95% CI 1.3-2.2, p=< 0.001). Postoperative acute heart failure following non-cardiac surgery was associated with significantly higher 1-year all-cause mortality (44% vs. 11%; aHR 1.7, 95% CI 1.3-2.2; p<0.001).
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