Perioperative risk assessment among patients with congestive heart failure: a call for guidelines

Each year, more than 10 million major noncardiac surgical procedures are performed in the United States. Current perioperative risk assessment focusing on ischemic heart disease and adherence to practice guidelines reduces morbidity and mortality. An estimated 10 million people in the United States suffer from ventricular dysfunction (class B), and half are symptomatic (class C), despite medical therapy. Individuals with heart failure who undergo surgical procedures are at higher risk for perioperative complications than those with ischemic heart disease. Currently, there are no consensus statements on the best approaches to risk-stratify individuals with heart failure who undergo surgical procedures. This manuscript reviews the current literature regarding risk assessment and perioperative management of patients with heart failure undergoing noncardiac surgical procedures. The authors will support the widespread use of two-dimensional echocardiogram with Doppler along with clinical criteria as the foundation of risk assessment. A simple algorithm will be discussed to help unify concepts and set the foundations for further research.