Comparison of Perioperative Outcomes in Heart Failure Patients With Reduced Versus Preserved Ejection Fraction After Noncardiac Surgery

Objective: To compare outcome after noncardiac surgery between HF patients with reduced versus preserved ejection fraction. Summary of Background Data: HF patients who undergo major noncardiac surgery have higher risks of morbidity and mortality compared to the general population. However, it is unclear whether HF subtypes confer different risk. Methods: This retrospective study included HF patients, 45 years or older, who underwent noncardiac surgery from January 1, 2010 to September 30, 2015 in the Nationwide Readmissions Database. Multivariable logistic regression models were used to provide adjusted rates of postoperative outcomes. Hospital-level clustering and Nationwide Readmissions Database sampling weights were applied to all models. Results: Of the weighted 296,057 HF patients [HF with reduced ejection fraction (HFrEF) 48.1%; HF with preserved ejection fraction (HFpEF) 51.9%] who underwent noncardiac surgery, 41.1% had cardiopulmonary complications, 55.7% had noncardiopulmonary complications and 5.4% died during hospitalization. Thirty-day readmission rates for the weighted 232,852 HF patients was 21.5%. The adjusted odds ratios of cardiopulmonary and noncardiopulmonary complications, in-hospital mortality and 30-day readmission for HFrEF compared to HFpEF patients were 1.01 [95% confidence interval (CI), 0.99-1.04], 1.05 (95% CI, 1.02-1.07), 1.27 (95% CI, 1.21-1.34), and 1.08 (95% CI, 1.05-1.12), respectively. Conclusions: HFrEF patients have increased risks of noncardiopulmonary complications, mortality, and readmission after noncardiac surgery. These findings suggest that targeted perioperative care for HF subtypes may be crucial for the growing population of HF patients undergoing noncardiac surgery. Despite cardiopulmonary complications not being statistically different between HF subtypes, given the high occurrence rate, any intervention to decrease the rate would be clinically meaningful.

Automated summary

HF patients with reduced ejection fraction have increased risks of noncardiopulmonary complications, mortality, and readmission after noncardiac surgery compared to those with preserved ejection fraction. Targeted perioperative care for different HF subtypes may be crucial for improving outcomes in this patient population. Despite no statistically significant difference in cardiopulmonary complications between HF subtypes, interventions to reduce the occurrence rate may still be clinically meaningful.