Safety of Gastrointestinal Endoscopic Procedures in Patients With Severe Heart Failure

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Introduction: Gastrointestinal (GI) endoscopic procedures are minimally invasive; however, there is evidence to suggest they may precipitate cardiovascular hemodynamic complications such as arrhythmias and myocardial infarction. These complications are more common in patients with primary cardiovascular and pulmonary diseases. Heart failure is a well-recognized factor for perioperative and postoperative cardiac events. Our aim to assess the factors associated with the safety and peri-procedural complications of GI endoscopies in patients with severe heart failure (defined as systolic heart failure with ejection fraction less than 30%, or severe diastolic heart failure). Methods: Through retrospective chart review, we collected de-identified data about patients with severe heart failure who underwent GI endoscopies at St Luke's hospital Kansas City MO. We assessed incidence of complications and mortality in the 30 days following procedure. Results: Our study included 207 patients with severe heart failure. Mean age was 64.8 years with 142 (68.9%) males. Sample included 133 (64.3%) Caucasian patients, 62 (30%) of African American population. Around half of our sample presented with heart failure exacerbation with fluid overload 95 (45.5%). All our patients underwent some sort of GI procedure (EGD 47.8%, Colonoscopy 15.4%, both 29.4%, other procedures 7.4%). Mortality within 30 days after procedure was 4.3% (9/207). The 30-day complications incidence was 19.8% (41/207) compared to around 0.5-1% incidence in literature. Immediate complications within hours of procedure was determined to be 21.3% (44/207) compared to 1.4% incidence in literature. Factors this study included were all found to positively correlate with mortality; especially positive smoking history (P=0.006, OR 6.87), history of recent MI (P=0.04, OR 4.4), elevated INR (P=0.03, OR 2.08)). Moreover, the 30-day complications were significantly associated with hyper-volemic status (P=0.035), NYHA class (P=0.02), positive smoking history (P=0.003). Whereas, the immediate complications were significantly associated with increased BMI (P=0.032, OR 1.07), Presence of lung disease (P=0.011, OR 3.13). Conclusion: Severe heart failure patients are at high risk for mortality and complications after GI procedures. Several factors are especially associated with such risk and within limitations of a retrospective study can predict poor outcome.