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Multicenter Study
. 2025 Aug;80(8):927-934.
doi: 10.1111/anae.16607. Epub 2025 Apr 15.

Outcomes in patients with chronic heart failure undergoing non-cardiac surgery: a secondary analysis of the METREPAIR international cohort study

Anna Kirkopoulos  1 , René M'Pembele  1 , Sebastian Roth  1 , Alexandra Stroda  1 , Jan Larmann  2 , Hans-Joerg Gillmann  3 , Katarzyna Kotfis  4 , Michael T Ganter  5 , Daniel Bolliger  6 , Miodrag Filipovic  7 , Luca Guzzetti  8 , Eckhard Mauermann  9 , Daniela Ionescu  10 , Savino Spadaro  11 , Wojciech Szczeklik  12 , Stefan De Hert  13 , Beatrice Beck-Schimmer  14 , Simon J Howell  15 , Giovanna A Lurati Buse  1 ; METREPAIR Investigators
Collaborators, Affiliations
Multicenter Study

Outcomes in patients with chronic heart failure undergoing non-cardiac surgery: a secondary analysis of the METREPAIR international cohort study

Anna Kirkopoulos et al. Anaesthesia. 2025 Aug.

Abstract

Introduction: Heart failure is a frequent comorbidity in patients undergoing non-cardiac surgery and an acknowledged risk factor for postoperative mortality. The associations between stable chronic heart failure and postoperative outcomes have not been explored extensively. The aim of this study was to determine associations between stable chronic heart failure and its peri-operative management and postoperative outcomes after major non-cardiac surgery.

Methods: This is a secondary analysis of MET-REPAIR, an international prospective cohort study including patients undergoing non-cardiac surgery aged ≥ 45 y with increased cardiovascular risk. Main exposures were stable chronic heart failure and availability of a pre-operative transthoracic echocardiogram. The primary endpoint was the incidence of postoperative major adverse cardiovascular events at 30 days. Secondary endpoints included 30-day mortality and severe in-hospital complications. Multivariable logistic regression models were calculated.

Results: Of 15,158 included patients, 3880 (25.6%) fulfilled the diagnostic criteria for stable chronic heart failure, of whom 1397 (36%) were female. Chronic heart failure was associated with increased risk of postoperative 30-day major adverse cardiovascular events (OR 2.04, 95%CI 1.59-2.60), 30-day mortality (OR 1.50, 95%CI 1.17-1.92) and in-hospital complications (OR 1.47, 95%CI 1.30-1.66). Transthoracic echocardiography was performed in 1267 (32.7%) patients with heart failure; 146 (11.5%) patients with heart failure presented with a left ventricular ejection fraction < 40%. Reduced ejection fraction was associated with major adverse cardiovascular events (OR 2.0, 95%CI 1.01-3.81).

Discussion: Stable chronic heart failure is independently associated with major adverse cardiovascular events, mortality and severe postoperative complications when measured 30 days after non-cardiac surgery.

Keywords: cardiovascular risk; guideline adherence; mortality; postoperative complications.

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