RESUMO
INTRODUCTION: The 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. METHODS: This 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. RESULTS: The 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]). CONCLUSION: Nurse-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.
Assuntos
Estudos de Viabilidade , Insuficiência Cardíaca , Complicações Pós-Operatórias , Qualidade de Vida , Humanos , Projetos Piloto , Feminino , Masculino , Idoso , Estudos Prospectivos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Fatores de Tempo , Pessoa de Meia-IdadeRESUMO
The term amyloidosis summarizes heterogeneous diseases in which a misfolding of protein structures occurs. These misfolded proteins can fundamentally be deposited anywhere in the body and lead to malfunction of the affected organ. There are preferential sites of deposition depending on which protein is misfolded. Cardiac transthyretin (ATTR) amyloidosis is a rare cause of cardiomyopathy and part of an underdiagnosed systemic disease. For cardiac ATTR amyloidosis, which involves deposition of misfolded tranthyretin either as a wild type (wtATTR) or as a mutated form (mATTR or hATTR), evidence-based treatment options have recently become available with slowing of the progression of the cardiomyopathy and a significant reduction of hospitalization rates. Therefore, it is important to diagnose this severe disease at an early stage and to differentiate it from other forms of amyloidosis. A clinical screening is easily possible by determination of free light chains using imaging examinations (cardiac magnetic resonance imaging or scintigraphic procedures) and immunofixation before the definitive diagnosis is made based on a biopsy and/or genetic tests. An interdisciplinary work-up involving hemato-oncology, nephrology, neurology and other disciplines, is indispensable when cardiac amyloidosis is suspected.