[J Am Coll Cardiol. 2004 Oct 6;44(7):1446-53] This study looked at 1,532 heart failure (HF) patients and 1,757 coronary artery disease (CAD) patients who 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). The authors conclude that 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. COMMENT: The HF patients in this study were shown to have about an 80% increased risk of mortality compared with CAD and control patients.

http://www.ncbi.nlm.nih.gov/entrez/...t_uids=15464326

Outcomes in heart failure patients after major noncardiac surgery.

Hernandez AF, Whellan DJ, Stroud S, Sun JL, O'Connor CM, Jollis JG.

Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. herna014@mc.duke.edu