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PostPosted: 09 Sep 2019 22:35 
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A report in JAMA earlier this year indicated that even relatively healthy heart failure patients may still be more likely to die after surgery than people with healthier hearts. People with CHF have symptoms such as shortness of breath, swelling of the legs, and tiredness. Before developing symptoms from CHF, many people have abnormal left ventricles that don't empty well. This condition is called Asymptomatic left ventricular systolic dysfunction.

For heart failure patients with obvious symptoms, surgery has long been associated with a greater risk of complications and death. But the current study offers fresh evidence that even heart failure patients without symptoms have an increased mortality risk. Researchers analyzed 90-day surgical mortality rates for nearly 48,000 patients with heart failure and nearly 562,000 patients without heart failure. None of them had emergency operations or heart surgery.

During the study, 2,635 people with heart failure, or 5.5 percent, died within 90 days of their operations, as did 6,881 patients without heart failure, or 1.2 percent.

Symptomatic heart failure patients were more than twice as likely to die as people without heart failure, the study found. Asymptomatic heart failure patients were still 53 percent more likely to die.

Patients with heart failure can also develop what’s known as a decreased left ventricular ejection fraction, or a reduced ability of the heart’s main pumping chamber to push oxygenated blood out of the heart into the rest of the body.

In the study, even heart failure patients without symptoms and with a normal ejection fraction were still 46 percent more likely to die after surgery than people without heart failure.

The heart failure patients were more likely to be male, obese, white, and older — 69 years old on average compared with 59 for people without heart failure. They also tended to have more complex chronic health problems than people without heart failure.

“Elective surgeries can stress the body due to anesthesia, administration of fluids, surgical bleeding, and/or addition of new medications, and these stressors can destabilize a patient with heart failure even if his/her symptoms were well controlled prior to surgery.”

In some instances, heart failure patients with symptoms or with decreased pumping ability may want to put off elective surgery, said Dr. Clare Atzema of the University of Toronto and the Sunnybrook Research Institute.

My Comment: Asymptomatic left ventricular systolic dysfunction (LVSD) can usually be diagnosed by echocardiography. Does this mean all patients must have echocardiography before surgery. The report is not very clear on this. It makes it even more confusing by suggesting that heart failure patients without symptoms and with a normal ejection fraction were still 46 percent more likely to die after surgery than people without heart failure


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