title: Impact of heart failure on hip fracture outcomes: a population-based study.
abstract: BACKGROUND
  Hip fracture and heart failure are becoming more prevalent conditions in hospitalized patients. Despite differences in postoperative outcomes from other intermediate risk procedures, guidelines classify hip fracture repair as an intermediate risk operation.
  
  
  OBJECTIVE
  This population-based study sought to examine the prevalence and incidence of heart failure in hip fracture patients.
  
  
  METHODS
  We conducted a population-based historical cohort study of 1116 Olmsted County, MN residents undergoing 1212 hip surgeries from 1988 through 2002. Data were obtained through medical record review. Heart failure was defined by Framingham criteria.
  
  
  RESULTS
  The prevalence of preoperative heart failure in our study population was 27% (327 of 1212 cases). Those with preoperative heart failure demonstrated longer lengths of stay, were more often discharged to a skilled facility, and had higher inpatient mortality rates. Rates of postoperative heart failure were 6.7% at seven days and 21.3% at one year. Postoperative heart failure was more common among those with preoperative heart failure (HR 3.0), and those with preoperative heart failure demonstrated higher postoperative mortality rates. Men had a higher risk of postoperative mortality compared to women. Overall survival was lowest among those with both preoperative and postoperative heart failure.
  
  
  CONCLUSIONS
  Heart failure represents a common and serious perioperative condition in hip fracture patients. Hip fracture patients with and without heart failure carry higher postoperative risk than guidelines may suggest. Future work must focus on the perioperative management of hip fracture patients with and without heart failure to mitigate postoperative morbidity.
authors: College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. cullen.michael@mayo.edu
authors: Michael W
authors: MW
authors: Cullen
authors: Rachel E
authors: RE
authors: Gullerud
authors: Dirk R
authors: DR
authors: Larson
authors: L Joseph
authors: LJ
authors: Melton
authors: Jeanne M
authors: JM
authors: Huddleston
mesh_terms: D000369:Aged, 80 and over; D016001:Confidence Intervals; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D011300:Preoperative Care; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology