Earlier Is Better: Preop β-Blockers in Vascular Surgery Patients

Guidelines suggest that when β-blockers are indicated for vascular surgery patients, therapy should be initiated days to weeks before surgery (Eur Heart J 2009; 30:2769). However, no prospective trials have been conducted to address optimal timing.

Investigators in the Netherlands examined a retrospective cohort of 940 vascular surgery patients who were classified according to timing of β-blocker initiation before surgery: <1 week, 1–4 weeks, or >4 weeks. Most patients (70%) received bisoprolol. Mean follow-up was 2 years. The primary endpoints were adverse cardiovascular events at 30 days and long-term mortality. Preoperative heart rate and high-sensitivity C-reactive protein (hsCRP; a marker used to stratify cardiovascular risk) level also…