A recent study revealed an association between accurate diagnosis of heart failure, lower intraoperative fluid administration and a reduced risk of postoperative AKI. (Pexels) (Pexels)
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Accurate Heart Failure Diagnosis Before Surgery Cuts Complications

The impact of accurate diagnosis of heart failure in adult patients influenced intraoperative practice patterns and postoperative outcomes

Dr. Disha Merlyn Mathias

A recent study [1] published in the British Journal of Anesthesia highlighted the important association between accurate diagnosis of heart failure before major non-cardiac surgery, lower intraoperative fluid administration (primary outcome), and a reduced risk of postoperative acute kidney injury/AKI (secondary outcome) in adult patients.

Conduct of the study: 

The research was conducted in a single academic hospital involving patients undergoing major non-cardiac surgeries, for the span of 4 years from 2015 to 2019. The study employed diagnostic codes, keywords in the preoperative assessment and medical records, later reviewed by a multispecialty panel to confirm preoperative heart failure diagnosis.

Key Results:

The impact of accurate diagnosis of heart failure in adult patients influenced intraoperative practice patterns and postoperative outcomes. (Pexels)

The study revealed that patients accurately diagnosed with heart failure before non-cardiac surgery tend to require low intraoperative fluid (On average, < 470ml) and a reduction in the risk of postoperative AKI (adjusted odds ratio: 0.39) than those with undiagnosed heart failure. 

  • False Negatives/True Positives: Patients with undiagnosed heart failure tends to have better left ventricular function and fewer comorbidities than those with an accurate diagnosis.

  • False Positives: Patients incorrectly diagnosed with heart failure were more likely to have lower ejection fractions, additional comorbidities, and were frequently undergoing thoracic surgeries.

Impact of this study and recommendations for improved diagnostic accuracy:

The impact of accurate diagnosis of heart failure in adult patients influenced the intraoperative practice patterns and postoperative outcomes, beyond fluid management and AKI risk, which includes:

  • Reduced sedative use

  • Greater use of arterial line monitoring and inotropes

  • Postoperative lactate levels reached lower peak levels

  • Shorter hospital stays

  • Fewer Vasopressor Infusions

However, this study is observational, and a single-institution setting limits generalizability. Future research should explore broader populations and additional perioperative management strategies optimizing patient care.

References:

1. Deniau, Benjamin, Valentine Léopold, and Alexandre Mebazaa. "Accurate Diagnosis of Heart Failure and Improved Perioperative Outcomes." British Journal of Anaesthesia 134, no. 1 (January 2025): 1–4. https://doi.org/10.1016/j.bja.2024.10.003.

(Input from various media sources)

(Rehash/Dr. Disha Merlyn Mathias/SSK)

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