Toward a More Discriminating Approach to Perioperative β-Blockade

Observational findings suggest significant benefit with β-blocker use during surgery in patients with ischemic heart disease and heart failure or recent myocardial infarction.

Current American College of Cardiology/American Heart Association guidelines for perioperative management recommend continuing β-blockers in patients already receiving them; however, given evidence suggesting harm in the latest randomized trials (NEJM JW Cardiol May 14 2008), recommendations for initiating therapy in the preoperative setting are relatively cautious.

Now, investigators in Demark have assessed the relationship between the use of β-blockers (defined as an outpatient prescription claim within 4 months before surgery) and major cardiovascular adverse events (MACE; ischemic stroke, myocardial infarction[MI], or cardiovascular death) and all-cause mortality within 30 days after noncardiac surgery. In a national-registry cohort of 2…

Reviewing Author

Frederick A. Masoudi, MD, MSPH, FACC, FAHA

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)