Perioperative Risk Assessment Among Patient with Congestive Heart Failure: A Call for Guidelines

More than 10 million major noncardiac surgical procedures are performed annually. Current perioperative risk assessment has focused on ischemic heart disease and shows that adherence to practice guidelines reduces morbidity and mortality. An estimated 10 million people in the United States suffer from ventricular dysfunction (class B), and half are symptomatic (class C) despite medical therapy. Individuals with heart failure who undergo surgical procedures are at higher risk for perioperative complications than those with ischemic heart disease. There is no current consensus on the best approaches to risk stratify individuals with heart failure who undergo surgical procedures. This review will provide information on the current state of risk assessment for heart failure and emphasize the role of 2D/Doppler echocardiography as a tool to optimally stratify risk.