Comprehensive Perioperative Anesthesia Management for Heart Failure Patients Undergoing Noncardiac Surgery: A Guideline-Based Review

ABSTRACT: Background: Heart failure (HF) patients are at significantly higher risk during noncardiac surgery, with mortality rates topping 10%. This review consolidates evidence-based strategies to optimize perioperative outcomes. Methods: We synthesized literature from major guidelines (ASA, ESAIC, AHA/ACC 2024, ESC 2022), UpToDate, core textbooks (Barash, Miller, Morgan & Mikhail), and pivotal trials (e.g., DECREASE, POISE-3).Results: Critical themes emerged: preoperative risk stratification (using BNP/NT-proBNP, echo), intraoperative hemodynamic precision (goal-directed fluids, advanced monitoring), and postoperative vigilance (early extubation, biomarker tracking). Crucially, continuing guideline-directed medical therapy (GDMT) is non-negotiable. Conclusion: Multidisciplinary, guideline-driven care slashes complications. Keywords: Heart failure (HF), noncardiac surgery, Perioperative Anesthesia