Hypothesis: “To determine the risk of postoperative mortality among patients with heart failure at various levels of echocardiographic (left ventricular systolic dysfunction) and clinical (symptoms) severity compared with those without heart failure and to evaluate how risk varies across levels of surgical complexity.”
Methods: Approximately 48,000 patients with heart failure and 562,000 patients without heart failure were compared. Cases were obtained from the VASQIP database and excluded cardiac and emergent surgery. Primary outcome was 90-day postoperative mortality evaluated by three multivariable mixed effects regression models.
Results: 90-day mortality was higher in patients with heart failure (5.5% vs 1.2%; adjusted odds ratio 1.67 [95% CI, 1.57-1.76]). Patients with symptomatic heart failure experienced even greater 90-day mortality (10.1% vs 1.2%; adjusted OR, 2.37 [95% CI, 2.14-2.63]).
Strengths: Large sample; accounted for multiple confounders
Weaknesses: Limited generalizability (VA, fewer women included in study); echocardiograms used for estimation of EF could have been from prior five years (possibly outdated); no control group.
Key Point: Heart failure is associated with an increased risk of postoperative mortality.