Should Heart Failure and Atrial Fibrillation be Considered in Determining the Risk of Noncardiac Surgery?

A history of coronary artery disease has long been considered as a predictor of a higher postoperative risk after noncardiac surgery. Most of the strategies to reduce the risk have been focused on this clinical condition.1–3Article see p 289Much less evidence is available on the predictors of noncardiac postoperative risk related to a diagnosis of heart failure for at least 2 reasons: (a) the weak definition of documented heart failure common in most studies, and (b) the relatively low number of events on which the evidence is based. Atrial fibrillation has been considered even less, and very scarce information is available on the role of this frequent arrhythmia in predicting the postoperative risk of noncardiac surgery.This lack of evidence is particularly relevant because both clinical conditions—heart failure4–8 and atrial fibrillation, even more so,9–12—are increasing in prevalence, determining a relevant burden on healthcare systems. Specifically, with increasing age and the improvement of treatments of acute coronary syndromes, heart failure is the most frequent cause of hospitalization in both the United States and Europe today. Although atrial fibrillation is less severe in terms of mortality and morbidity than heart failure, it is now the arrhythmia most frequently seen in clinical practice and is not without adverse consequences.The article by van Diepen et al13 has the merit of focusing attention on the …