Acute heart failure after non-cardiac surgery: incidence, phenotypes, determinants and outcomes

Danielle M Gualandro; Christian Puelacher; Michelle S Chew; Henrik Andersson; Giovanna Lurati Buse; Noemi Glarner; Daria Mueller; Francisco A M Cardozo; Katrin Burri-Winkler; Constantin Mork; Desiree Wussler; Samyut Shrestha; Isabelle Heidelberger; Mikael Fält; Reka Hidvegi; Daniel Bolliger; Andreas Lampart; Luzius A Steiner; Stefan Schären; Christoph Kindler; Lorenz Gürke; Daniel Rikli; Didier Lardinois; Stefan Osswald; Andreas Buser; Bruno Caramelli; Christian Mueller; BASEL-PMI Investigators

doi:10.1002/ejhf.2773

Acute heart failure after non-cardiac surgery: incidence, phenotypes, determinants and outcomes

Eur J Heart Fail. 2023 Mar;25(3):347-357. doi: 10.1002/ejhf.2773. Epub 2023 Feb 7.

Authors

Danielle M Gualandro^#^{1

2}, Christian Puelacher^#¹, Michelle S Chew³, Henrik Andersson³, Giovanna Lurati Buse⁴, Noemi Glarner¹, Daria Mueller¹, Francisco A M Cardozo², Katrin Burri-Winkler¹, Constantin Mork¹, Desiree Wussler^{1

5}, Samyut Shrestha¹, Isabelle Heidelberger¹, Mikael Fält³, Reka Hidvegi^{1

6}, Daniel Bolliger⁷, Andreas Lampart⁷, Luzius A Steiner^{7

8}, Stefan Schären⁹, Christoph Kindler¹⁰, Lorenz Gürke¹¹, Daniel Rikli¹², Didier Lardinois¹³, Stefan Osswald¹, Andreas Buser¹⁴, Bruno Caramelli², Christian Mueller¹; BASEL-PMI Investigators

Affiliations

¹ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
² Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
³ Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
⁴ Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany.
⁵ Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
⁶ Department of Anesthesiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
⁷ Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland.
⁸ Department of Clinical Research, University of Basel, Basel, Switzerland.
⁹ Department of Spinal Surgery, University Hospital Basel, Basel, Switzerland.
¹⁰ Department of Anesthesiology, Kantonsspital Aarau, Aarau, Switzerland.
¹¹ Department of Vascular Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.
¹² Clinic for Orthopedics and Trauma Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.
¹³ Department of Thoracic Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.
¹⁴ Department of Hematology and Blutspendezentrum, University Hospital Basel, University of Basel, Basel, Switzerland.

^# Contributed equally.

PMID: 36644890
DOI: 10.1002/ejhf.2773

Abstract

Aims: Primary acute heart failure (AHF) is a common cause of hospitalization. AHF may also develop postoperatively (pAHF). The aim of this study was to assess the incidence, phenotypes, determinants and outcomes of pAHF following non-cardiac surgery.

Methods and results: A total of 9164 consecutive high-risk patients undergoing 11 262 non-cardiac inpatient surgeries were prospectively included. The incidence, phenotypes, determinants and outcome of pAHF, centrally adjudicated by independent cardiologists, were determined. The incidence of pAHF was 2.5% (95% confidence interval [CI] 2.2-2.8%); 51% of pAHF occurred in patients without known heart failure (de novo pAHF), and 49% in patients with chronic heart failure. Among patients with chronic heart failure, 10% developed pAHF, and among patients without a history of heart failure, 1.5% developed pAHF. Chronic heart failure, diabetes, urgent/emergent surgery, atrial fibrillation, cardiac troponin elevations above the 99th percentile, chronic obstructive pulmonary disease, anaemia, peripheral artery disease, coronary artery disease, and age, were independent predictors of pAHF in the logistic regression model. Patients with pAHF had significantly higher all-cause mortality (44% vs. 11%, p < 0.001) and AHF readmission (15% vs. 2%, p < 0.001) within 1 year than patients without pAHF. After Cox regression analysis, pAHF was an independent predictor of all-cause mortality (adjusted hazard ratio [aHR] 1.7 [95% CI 1.3-2.2]; p < 0.001) and AHF readmission (aHR 2.3 [95% CI 1.5-3.7]; p < 0.001). Findings were confirmed in an external validation cohort using a prospective multicentre cohort of 1250 patients (incidence of pAHF 2.4% [95% CI 1.6-3.3%]).

Conclusions: Postoperative AHF frequently developed following non-cardiac surgery, being de novo in half of cases, and associated with a very high mortality.

Keywords: Acute heart failure; Heart failure; Non-cardiac surgery; Postoperative.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Chronic Disease
Heart Failure*
Humans
Incidence
Phenotype
Prospective Studies