Randomized Pilot Trial of Pre‐ and Postoperative Heart Failure Nurse‐Supported Care in Heart Failure Patients Requiring Noncardiac Surgery—Feasibility and Results

Abstract

ABSTRACTIntroductionThe perioperative cardiovascular management of patients undergoing noncardiac surgery is particularly challenging in those with pre‐existing heart failure (HF). This study was designed to evaluate the effectiveness of nurse‐based pre‐ and postoperative specialized HF management in reducing postoperative HF‐associated complications in patients with known HF undergoing noncardiac surgery.MethodsThis prospective, randomized pilot study included patients with established HF requiring intermediate‐ to high‐risk noncardiac surgery. Patients received postoperatively either standard care (control group, CG) or nurse‐supported HF management (intervention group, IG). The primary endpoint was a composite of HF‐related postoperative complications at 30 days. Secondary endpoints included length on intensive care unit, length of hospital stay, death, hospitalization for HF, and quality of life assessment using the SF‐12 questionnaire.ResultsThe trial was halted prematurely for futility. A total of 34 patients (median age 70.5 [IQR 67–75] years; with 15 HfpEF, 9 HfmrEF,10 HfrEF), with an average NT‐proBNP of 1.413 [463–2.832] pg/mL were included. The IG had a lower rate of postoperative primary events (25%; n = 4) compared with the CG (33%; n = 6). There were no differences in secondary endpoints between the groups. Quality‐of‐life scores improved slightly in both groups (δ 5.6 ± 0.9 [CG] and 3.1 ± 1.2 [IG]).ConclusionNurse‐based pre‐ and postoperative HF care appears to be feasible and may reduce HF‐associated complications in patients undergoing noncardiac surgery. Larger clinical trials are needed to further evaluate the effectiveness of this approach in reducing postoperative complications in this high‐risk patient population.