Perioperative Anesthetic Management in Patients With Heart Failure: From Risk Assessment to Hemodynamic Optimization, Integrating Functional Capacity Assessment and Exercise Prehabilitation – A Narrative Review

Background: Heart failure (HF) increases perioperative complications and mortality in patients undergoing non-cardiac surgery. Both heart failure with reduced ejection fraction and preserved ejection fraction increase cardiovascular risk and require perioperative management. Aim: This review summarizes evidence on perioperative anesthetic management in patients with HF undergoing non-cardiac surgery, focusing on risk assessment, medical therapy optimization, intraoperative hemodynamic management, fluid therapy, postoperative monitoring and impact of exercise on recovery. Materials and Methods: This narrative review included PubMed-indexed studies published between 2021 and 2026. ESC consensus statements, randomized trials, and large cohort studies were analyzed to summarize practical recommendations for perioperative management of HF. Results: Preoperative evaluation should include clinical assessment, natriuretic peptide measurement, and echocardiography. Optimization of medical therapy and euvolemia is essential. During surgery, maintaining MAP ≥ 65 mmHg, careful fluid therapy, and early vasopressor use may reduce myocardial injury. Conclusions: Perioperative management of patients with heart failure should include risk assessment, prehabilitation, hemodynamic control, multidisciplinary care, and functional capacity evaluation to improve short-term outcomes.