Heart Care Info - Heart Disease Prevention & Treatment

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

S van Diepen, JA Ezekowitz, JA Bakal... - Circulation, 2012 - Am Heart Assoc We thank Drs Chatterjee and Chakraborty for their insightful comments. We acknowledge that studies on the general epidemiology of heart failure demonstrate that patients with an ischemic pathogenesis for heart failure have a worse prognosis than those with ...

We thank Drs Chatterjee and Chakraborty for their insightful comments. We acknowledge that studies on the general epidemiology of heart failure demonstrate that patients with an ischemic pathogenesis for heart failure have a worse prognosis than those with nonischemic heart failure; however, there are few publications that explore this relationship in the perioperative setting. A cohort from the United States with the use of administrative data reported no difference in perioperative outcomes between ischemic heart failure and nonischemic heart failure patients.1 Our study used up to 13 years of inpatient and procedural administrative data, rather than a single data source, to create our ischemic heart failure and nonischemic heart failure cohorts.2 We hypothesize this observed difference may be explained, in part, by the comprehensive methods used to separate the ischemic heart failure and nonischemic heart failure cohorts in our study. Irrespective of this difference, our study adds to evidence that patients with heart failure are at increased risk of adverse perioperative outcomes. Information regarding perioperative β-blocker management, heart rhythm, heart rate, or blood pressure control is not available in our dataset, and to date this has not been extensively studied as to the relative risks, benefits, or harms of any of these items. Finally, our dataset does not distinguish between paroxysmal or permanent atrial fibrillation, nor does it include patients with nonhospitalized atrial fibrillation. We believe that this question merits future evaluation in a dataset with these additional data points.