Cardiac Optimisation in Proximal Femoral Fractures in the Elderly

Area of Science:

• Geriatric Medicine
• Cardiology
• Orthopedic Surgery

Background:

• Fragility hip fractures are common in the elderly, leading to significant morbidity and mortality.
• Cardiovascular comorbidities worsen outcomes in these patients.
• Perioperative cardiac complications are a major concern in hip fracture repair.

Purpose of the Study:

• To review perioperative cardiac complications in elderly patients with fragility hip fractures.
• To evaluate optimization strategies for cardiac care, focusing on specific complications.
• To emphasize management of postoperative atrial fibrillation (POAF), acute myocardial infarction (AMI), heart failure, and cardiac implantable electronic devices (CIEDs).

Main Methods:

• Conducted a narrative review of literature from PubMed, Embase, and Cochrane Library (Jan 2000-Mar 2024).
• Included relevant guidelines from NICE, ESC, and ACC/AHA.
• Utilized search terms related to hip fractures, cardiac complications, and specific cardiac conditions/devices.

Main Results:

• Postoperative atrial fibrillation (POAF) affects ~3-4% of elderly hip fracture patients, increasing one-year mortality significantly (60% vs. 19.5%).
• Risk factors for POAF include surgical delay beyond 48 hours and >2 units of packed red blood cell transfusion.
• Acute myocardial infarction (AMI) and heart failure are often underdiagnosed due to atypical presentations; CIED management requires multidisciplinary coordination.

Conclusions:

• Cardiac optimization in elderly hip fracture patients is challenging due to limited evidence and varied practices.
• Developing validated POAF risk prediction tools is essential.
• Standardized protocols and multidisciplinary pathways are needed to improve outcomes and reduce healthcare burden.