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HEART FAILURE

Outcomes in heart failure patients after major noncardiac surgery

Adrian F. Hernandez, MD^*,*, David J. Whellan, MD, MHS^*, Sharon Stroud, BS, Jie Lena Sun, MS, Christopher M. O'Connor, MD, FACC^* and James G. Jollis, MD, FACC^*

^* Division of Cardiology, Departmentof Medicine, Duke University Medical Center, Durham, North Carolina
Duke Clinical Research Institute, Durham, North Carolina

Manuscript received February 2, 2004; revised manuscript received June 2, 2004, accepted June 22, 2004.

^* Reprint requests and correspondence: Dr. Adrian F. Hernandez, Duke Clinical Research Institute, P.O. Box 17969, Durham, North Carolina 27715 (Email: herna014{at}mc.duke.edu).

OBJECTIVES: The purpose of this study was to evaluate mortality and readmission rates of heart failure (HF) patients after major noncardiac surgery.

BACKGROUND: There is a lack of generalizable outcome data on HF patients undergoing major noncardiac surgery because previous studies have been limited to a few academic centers or have not focused on this group of patients.

METHODS: Using the 1997 to 1998 Standard Analytic File 5% Sample of Medicare beneficiaries, we identified patients with HF who underwent major noncardiac surgery. A multivariable logistic regression model was used to provide adjusted mortality and readmission rates in patients after noncardiac surgery. Patients with coronary artery disease (CAD) and all other remaining patients (Control) who had similar surgery served as reference groups.

RESULTS: Of 23,340 HF patients and 28,710 CAD patients, 1,532 (6.56%) HF patients and 1,757 (6.12%) CAD patients underwent major noncardiac surgery. There were 44,512 patients in the Control group with major noncardiac surgery. After accounting for demographic characteristics, type of surgery, and comorbid conditions, the risk-adjusted operative mortality (death before discharge or within 30 days of surgery) was HF 11.7%, CAD 6.6%, and Control 6.2% (HF vs. CAD, p < 0.001; CAD vs. Control, p = 0.518). The risk-adjusted 30-day readmission rate was HF 20.0%, CAD 14.2%, and Control 11.0% (p < 0.001).

CONCLUSIONS: In patients 65 years of age and older, HF patients undergoing major noncardiac surgery suffer substantial morbidity and mortality despite advances in perioperative care, whereas patients with CAD without HF have similar mortality compared with a more general population.

Abbreviations and Acronyms   CAD = coronary artery disease   HF = heart failure   ICD-9 = International Classification of Diseases-9th Revision   SNF = skilled nursing facility

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