Heart Care Info - Heart Disease Prevention & Treatment

... Regarding Article,“Mortality and Readmission of Patients With Heart Failure, Atrial Fibrillation, or Coronary Artery Disease Undergoing Noncardiac Surgery: An ...

S Chatterjee... - Circulation, 2012 - Am Heart Assoc We read with great interest the article by van Diepen et al 1 regarding effect of coronary artery disease (CAD), heart failure (both ischemic and nonischemic), and atrial fibrillation (AF) on mortality and readmission rates after noncardiac surgery. The well-written article ...

We read with great interest the article by van Diepen et al1 regarding effect of coronary artery disease (CAD), heart failure (both ischemic and nonischemic), and atrial fibrillation (AF) on mortality and readmission rates after noncardiac surgery. The well-written article attempts to identify perioperative risk factors beyond that of the well-known CAD by using a nested case-control study. However, a few interesting points arise from the analysis that we feel may be pertinent.

First, patients with nonischemic heart failure had the highest unadjusted 30-day mortality and readmission rates for the cohort. This seems a little counterintuitive, because rates of mortality with nonischemic heart failure, especially after optimal therapy, have been reported to be lower than with ischemic heart failure.2,3 It would also be of essence to know whether the authors adjusted for medical therapy of nonischemic heart failure/ischemic heart failure before surgery. It would be especially interesting to know of the effect of perioperative β-blockade on the nonischemic heart failure/ischemic heart failure and AF cohorts, considering its debatable mortality benefit as a preoperative therapy in CAD.4

Second, it would also be interesting to know whether the authors had data on the follow-up of the patients with all of the risk factors, ie, AF+ischemic heart failure+CAD (Venn diagram, in Figure 2 of the article), and if indeed the risk of mortality and readmissions went up incrementally with simultaneous presence of risk factors proportionately compared with the individual assessments against CAD.