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Acute heart failure in non-cardiac surgery.
Danielle M Gualandro1, Josep Masip2, Sigrun Halvorsen3,4
1Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, Basel CH-4056, Switzerland.
European Heart Journal
|August 21, 2025
Summary
Acute heart failure (AHF) after non-cardiac surgery is a serious complication with high mortality. This review focuses on understanding AHF pathophysiology, prevention, diagnosis, and treatment to improve patient outcomes.
Area of Science:
- Cardiology
- Perioperative Medicine
- Critical Care
Background:
- Acute heart failure (AHF) is a growing global health concern, particularly in elderly populations.
- Secondary AHF, a complication in hospitalized patients or post-surgery, remains understudied.
- AHF post-non-cardiac surgery has a very high mortality rate (up to 44% within 1 year).
Purpose of the Study:
- To review the pathophysiology, prevention, diagnosis, treatment, and prognosis of AHF after non-cardiac surgery.
- To highlight the critical need for research and education on secondary AHF.
- To emphasize the high mortality associated with AHF following non-cardiac surgery.
Main Methods:
- Literature review summarizing current evidence on AHF post-non-cardiac surgery.
- Analysis of pathophysiological mechanisms contributing to AHF in this context.
- Discussion of diagnostic tools and management strategies.
Main Results:
- Prevention strategies include managing fluid status, blood pressure, pain, anemia, and electrolytes.
- Cardiac biomarkers (troponins, natriuretic peptides) aid diagnosis and risk stratification.
- Echocardiography is recommended for diagnosis in this high-risk population.
Conclusions:
- Vigilant postoperative care is crucial for early AHF recognition and treatment.
- Addressing underlying pathophysiological factors can aid prevention.
- Improved understanding and management of AHF post-non-cardiac surgery can enhance patient outcomes.
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