Cardiac Optimisation in Proximal Femoral Fractures in the Elderly

Sadhin Subhash; Paul Njoku; Shahtajarab Saltanat; Mohammed F Millat; Sayam Subhash; Sarmila Tharmakulasingam; Maheswaran W Archunan; David T Loveday; George Smith; Ignatius Liew; Sebastian Ho

doi:10.7759/cureus.91027

Cardiac Optimisation in Proximal Femoral Fractures in the Elderly

Cureus. 2025 Aug 26;17(8):e91027. doi: 10.7759/cureus.91027. eCollection 2025 Aug.

Authors

Affiliations

¹ Trauma and Orthopaedics, East Suffolk and North Essex NHS Foundation Trust, Ipswich, GBR.
² Cardiology, Frimley Health NHS Foundation Trust, Ascot, GBR.
³ Trauma and Orthopaedics, Broomfield Hospital, Chelmsford, GBR.
⁴ Physiology, Government Medical College, Kollam, IND.
⁵ Oncology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, GBR.
⁶ Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, GBR.
⁷ Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, GBR.
⁸ Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR.

Abstract

Fragility hip fractures are increasingly common in elderly patients and are associated with high morbidity and mortality. Cardiovascular comorbidities-including ischaemic heart disease, heart failure, and valvular disease-contribute significantly to poor outcomes. This study aimed to review perioperative cardiac complications in elderly patients undergoing fragility hip fracture repair and evaluate strategies for optimisation, with emphasis on postoperative atrial fibrillation (POAF), acute myocardial infarction (AMI), heart failure, and management of cardiac implantable electronic devices (CIEDs). We conducted a narrative review drawing data from the databases PubMed, Embase, and the Cochrane Library (January 2000-March 2024). The search terms included "hip fracture," "cardiac complications," "postoperative atrial fibrillation," "myocardial infarction," "heart failure," "valvular disease," and "cardiac implantable electronic devices." Guidelines from the National Institute for Health and Care Excellence (NICE), the European Society of Cardiology (ESC), and the American College of Cardiology/American Heart Association (ACC/AHA) were also reviewed. POAF was observed in ~3-4% of elderly hip fracture patients and is associated with significantly higher one-year mortality (60% vs. 19.5%). Risk factors include surgical delay beyond 48 hours and transfusion of >2 units of packed red blood cells. AMI and perioperative heart failure are frequently underdiagnosed due to atypical presentations. CIED management requires multidisciplinary coordination to avoid device malfunction. Cardiac optimisation in fragility hip fracture patients remains challenging due to heterogeneous evidence and variable practice. Development of validated POAF risk prediction tools, standardised treatment protocols, and structured multidisciplinary pathways may help improve outcomes and reduce healthcare burden.

Keywords: acute and chronic heart failure; cardiac disease; fragility hip fractures; orthogeriatric medicine; orthopaedic surgery; pacemaker; perioperative acute myocardial infarction; post-operative atrial fibrillation.

Publication types

Review