Heart Failure a Concern for Non-Cardiac Surgeries
Older persons with heart failure face heightened odds of complications and death after non-cardiac surgeries, according to a study reported in the medical journal Anesthesiology.
"We're trying to draw attention to this major problem," says lead researcher Dr. Adrian F. Hernandez, at Duke University.
Heart failure, the progressive loss of the heart's ability to pump blood, is widespread among older Americans, but it sometimes is overlooked as a risk factor when surgery is needed, he says.
"Most physicians focus on whether [older patients] have coronary artery disease or have a risk of heart attack," says Dr. Hernandez. "Heart failure is by far a more important risk factor, but it doesn't usually have greater weight when they want to identify patients at risk of complications or consider how they want to treat them after surgery."
Symptoms of heart failure include shortness of breath, fatigue, and swelling of the legs.
Dr. Hernandez used Medicare data on more than 159,000 people undergoing major surgery not involving the heart, such as hip replacement operations. The study was the largest one ever conducted on this issue.
Past estimates have put the incidence of heart failure in the older population between 5 percent and 12 percent, but the new study found the condition in almost 20 percent of those having surgery.
The study divided the participants into three groups: those with heart failure, with or without coronary artery disease; those with only coronary artery disease; and those with neither condition.
Nearly 98 percent of all those who had surgery were discharged soon afterward from the hospital.
But 17.1 percent of those with heart failure had to be re-hospitalized within 30 days, compared to 10.8 percent of those with coronary artery disease and just 8.1 percent of those with neither ailment.
In the month after having surgery, 1.6 percent of those with heart failure died, compared to 0.5 percent for those with coronary artery disease and 0.3 percent of those with neither condition.
Steps can be taken to reduce the toll, notes Dr. Hernandez.
"The first thing is to check on what the conditions are that might influence the patients' outcomes," he says. "We have to identify therapies that lower the risk of a poor outcome and assure that all patients, when they have surgery, are carefully monitored."
Close attention should be paid to be sure that symptoms of heart failure are kept to a minimum, adds Dr. Hernandez. Medications such as beta blockers and diuretics can be used to keep heart failure under control.
But he notes that it is not certain how effective such measures might be in reducing risks - only a rigorous, controlled study could answer that question definitively.
Dr. Robert Hobbs, a cardiologist at the Cleveland Clinic, says the increase in surgery risk due to heart failure has been noted before, but "this is a big study that involves a lot of people. It solidifies that the risk is real, and the risk is substantial."
Measures that can be taken to reduce the risk include simply not performing surgery, if possible, on someone whose life might be endangered, says Dr. Hobbs.
"If surgery is necessary for someone with heart failure, there should be targeted use of heart failure medications before the operation and an effort to avoid overloading the body with intravenous fluid during the procedure," he says.
"And we would certainly watch them more carefully in the postoperative period," adds Dr. Hobbs.
Always consult your physician for more information.
Heart failure, also called congestive heart failure, is a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body's other organs.
The heart keeps pumping, but not as efficiently as a healthy heart. Usually, the loss in the heart's pumping action is a symptom of an underlying heart problem.
Heart failure affects nearly 5 million US adults. It is on the rise with an estimated 400,000 to 700,000 new cases each year.
Heart failure may result from any/all of the following:
- heart valve disease - caused by past rheumatic fever or other infections
- high blood pressure (hypertension)
- infections of the heart valves and/or heart muscle (i.e., endocarditis)
- previous heart attack(s) (myocardial infarction) - scar tissue from previous attacks may interfere with the heart muscle's ability to work normally
- coronary artery disease - narrowed arteries that supply blood to the heart muscle
- cardiomyopathy - or another primary disease of the heart muscle
- congenital heart disease/defects (present at birth)
- cardiac arrhythmias (irregular heartbeats)
- chronic lung disease and pulmonary embolism
- drug-induced heart failure
- excessive sodium intake
- hemorrhage and anemia
Heart failure interferes with the kidney's normal function of eliminating excess sodium and waste from the body. In heart failure, the body retains more fluid - resulting in swelling of the ankles and legs.
Fluid also collects in the lungs - resulting in shortness of breath.
The following are the most common symptoms of heart failure. However, each individual may experience symptoms differently. Symptoms may include:
- shortness of breath during rest, exercise, or lying flat
- weight gain
- visible swelling of the legs and ankles (due to a build-up of fluid), and, occasionally, the abdomen
- fatigue and weakness
- loss of appetite and nausea
- persistent cough - often produces mucus or blood-tinged sputum
- reduced urination
The severity of the condition and symptoms depends on how much of the heart's pumping capacity has been lost.
The symptoms of heart failure may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
Always consult your physician for more information.