Algorithm for patients with a heart failure syndrome with an indication for urgent noncardiac surgery

ACS: acute coronary syndrome; HF: heart failure; MACE: major adverse cardiac events; BNP: B-type natriuretic peptide; NT-proBNP: N-terminal pro-BNP.
* Refer to UpToDate content on management of ACS.
¶ Assessment of the HF syndrome includes clinical evaluation with selective use of preoperative tests based upon the likelihood of testing changing management. While we do not recommend routine preoperative measurement of BNP or NT-proBNP levels, measurement of BNP or NT-proBNP is helpful in patients with suspected HF when the diagnosis is uncertain and may also be helpful in patients with HF when disease stability is uncertain. During treatment with sacubitril-valsartan, plasma NT-proBNP levels (but not plasma BNP levels) can be used to assess HF.
Δ Stable HF syndromes include stable HF as well as asymptomatic left ventricular dysfunction.
◊ Refer to UpToDate content on management of heart failure with reduced ejection fraction, heart failure with preserved ejection fraction, heart failure with mid-range ejection fraction, and refractory heart failure.