Heart failure makes surgery risky for elderly

Older patients with heart failure have a two-fold higher rate of mortality and re-admission after undergoing non-cardiac surgery than other patients in their age group, a Duke University research team reports.

The prevalence of heart failure is increasing, as is the number of surgical procedures being performed on older patients, explain the Durham, North Carolina-based researchers. However, not much is known about surgery risks for heart failure patients, they note.

"Previous studies have demonstrated that heart failure is an important risk factor, but the magnitude may be under-appreciated," Dr. Adrian F. Hernandez and colleagues write in the Journal of the American College of Cardiology.

For their study, they analyzed data from Medicare claims files for some 1,500 patients with heart failure, 1,700 with coronary artery disease, and a comparison group of about 44,500 "control" subjects, who underwent major non-cardiac surgery. All of the subjects were 65 years of age or older.

Even after taking into account other factors, the mortality rate within 30 days of surgery was 11.7 percent among patients with heart failure, versus 6.6 percent for those with coronary disease and 6.2 percent for control subjects.

Among these three groups, 20.0 percent, 14.2 percent, and 11.0 percent were re-admitted to the hospital within 30 days.

"There appears to be an important need for surveillance of patients with a history of heart failure in the hospital to ensure that discharge is appropriate, plus close follow-up of outpatients to prevent re-admissions," Hernandez's team concludes.

SOURCE: Journal of the American College of Cardiology, October 6, 2004.