Postoperative Complications in Patients With Heart Failure With Reduced vs Preserved Ejection Fraction Undergoing...

Heart failure is a known risk factor for complications after arthroplasty, yet few studies separate heart failure with reduced ejection fraction (HFrEF; left ventricular ejection fraction ≤40%) from heart failure with preserved ejection fraction (HFpEF; left ventricular ejection fraction ≥50%). We evaluated whether heart failure subtype influences postoperative outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Using the TriNetX Network, we conducted a retrospective cohort study of adults with HFrEF or HFpEF undergoing elective primary THA or TKA (2004-2024). Propensity score matching (1:1) balanced demographics, comorbidities, medications, and laboratory values. Seven complications were assessed at 90 days and 1 year.

In the THA cohort (560 matched pairs), HFrEF was associated with higher odds of acute kidney failure (OR_1year = 1.63, P < .01), myocardial infarction (OR_90days = 1.66, P = .012), stroke (OR_90days = 3.11, P < .01), atrial fibrillation (OR_90days = 1.56, P < .01), and mortality (OR_1year = 1.54, P = .044); cardiac arrest and sepsis did not differ. In the TKA cohort (950 matched pairs), HFrEF was associated with higher odds of acute kidney failure (OR_1year = 1.45, P < .01), myocardial infarction (OR_1year = 1.93, P < .01), atrial fibrillation (OR_90days = 1.56, P < .01), mortality (OR_1year = 1.85, P < .01), and cardiac arrest (OR_1year = 2.37, P = .011); stroke and sepsis did not differ.

HFrEF confers higher risk than HFpEF after THA and TKA, supporting the need for HFrEF-specific perioperative management to improve outcomes.