CME: Beta-Blockade & Mortality in Non-Cardiac Surgery

CME: Beta-Blockade & Mortality in Non-Cardiac Surgery

While use of perioperative β-blockers is a widely accepted practice when managing patients undergoing cardiac surgery, using these medications in people who receive non-cardiac surgery is controversial. Years ago, perioperative β-blockade was recommended liberally for patients undergoing non-cardiac surgery after early research demonstrated initial success in patients with cardiac disease. However, this recommendation was based on findings from randomized clinical trials with small samples that may not have included the broad spectrum of patients seen in routine clinical practice. “While some of the initial studies found a benefit by using β-blockade in non-cardiac surgery, other investigations have shown no advantage to this practice,” says Mark L. Friedell, MD. “In fact, some trials have indicated that patients undergoing non-cardiac surgery could be at greater risk for hypotension and stroke if they use β-blockers.” This has created considerable uncertainty about the use of perioperative β-blockers, particularly in patients at low risk of myocardial ischemic events. Examining the Effects Dr. Friedell and colleagues had a study published in JAMA Surgery in which they performed a retrospective observational analysis of patients undergoing surgery in Veterans Affairs (VA) hospitals over a 5-year period. Use of β-blockers was established if a dose was ordered at any time between 8 hours before surgery and 24 hours after the procedure. The authors assessed 30-day mortality outcomes after perioperative β-blockade in patients undergoing non-cardiac surgery with different levels of cardiac risk. For the study, the authors analyzed demographics, diagnosis and procedural codes, medications, perioperative laboratory values, and dates of death. They then used a four-point cardiac risk score that was calculated by assigning one point each for renal...
Beta-Blockade & Mortality in Non-Cardiac Surgery

Beta-Blockade & Mortality in Non-Cardiac Surgery

While use of perioperative β-blockers is a widely accepted practice when managing patients undergoing cardiac surgery, using these medications in people who receive non-cardiac surgery is controversial. Years ago, perioperative β-blockade was recommended liberally for patients undergoing non-cardiac surgery after early research demonstrated initial success in patients with cardiac disease. However, this recommendation was based on findings from randomized clinical trials with small samples that may not have included the broad spectrum of patients seen in routine clinical practice. “While some of the initial studies found a benefit by using β-blockade in non-cardiac surgery, other investigations have shown no advantage to this practice,” says Mark L. Friedell, MD. “In fact, some trials have indicated that patients undergoing non-cardiac surgery could be at greater risk for hypotension and stroke if they use β-blockers.” This has created considerable uncertainty about the use of perioperative β-blockers, particularly in patients at low risk of myocardial ischemic events.   Examining the Effects Dr. Friedell and colleagues had a study published in JAMA Surgery in which they performed a retrospective observational analysis of patients undergoing surgery in Veterans Affairs (VA) hospitals over a 5-year period. Use of β-blockers was established if a dose was ordered at any time between 8 hours before surgery and 24 hours after the procedure. The authors assessed 30-day mortality outcomes after perioperative β-blockade in patients undergoing non-cardiac surgery with different levels of cardiac risk. For the study, the authors analyzed demographics, diagnosis and procedural codes, medications, perioperative laboratory values, and dates of death. They then used a four-point cardiac risk score that was calculated by assigning one point each for...