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Perioperative management of heart failure in patients undergoing noncardiac surgery

Theo E Meyer, MD, PhD
Section Editor
Stephen S Gottlieb, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Heart failure (HF) is one of the most common conditions requiring evaluation and treatment in patients undergoing noncardiac surgery. Ageing populations and progress in the treatment of chronic diseases such as hypertension, diabetes, and coronary artery disease are increasing the prevalence of HF [1]. In addition, elderly patients at risk for HF are undergoing noncardiac surgery at increasing rates. It is estimated that HF is present in almost 20 percent of older adults undergoing common surgical procedures in the United States [2]. HF is a major risk factor for adverse cardiac events, including death following noncardiac surgery [3].

Recommendations regarding perioperative cardiac evaluation and management of HF are reviewed here.

General management approaches for patients with acute and chronic HF are discussed separately. (See "Treatment of acute decompensated heart failure: General considerations" and "Treatment of acute decompensated heart failure: Components of therapy" and "Overview of the therapy of heart failure with reduced ejection fraction" and "Treatment and prognosis of heart failure with preserved ejection fraction".)

Management of patients with valve disease undergoing noncardiac surgery is discussed separately. (See "Noncardiac surgery in patients with aortic stenosis" and "Noncardiac surgery in patients with mitral or aortic regurgitation" and "Medical management and indications for intervention for mitral stenosis" and "Medical management and indications for intervention for mitral stenosis", section on 'Noncardiac surgery'.)


The general approach to management of perioperative heart failure includes preoperative evaluation and risk assessment, decision making regarding whether and when to proceed with surgery, and pre-, intra-, and postoperative management.

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Literature review current through: Oct 2017. | This topic last updated: May 10, 2017.
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