To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Use of Beta-Blockers Before Surgery Increases Risk of MI, Death After Surgery URL: http://www.pslgroup.com/dg/22F276.htm Doctor's Guide October 20, 2008
CHICAGO -- October 20, 2008 -- Some patients who received beta-blockers before and around the time of undergoing noncardiac surgery appear to have higher rates of heart attack and death within 30 days of their surgery, according to a report in the October issue of Archives of Surgery. Following observations of an increase in heart rate before such events and clinical reports of fewer complications in patients taking beta-blockers for hypertension, researchers began investigating whether these medications should be given to patients undergoing surgery. Haytham M. A. Kaafarani, MD, of the Veterans Affairs Boston Health Care System, Boston University and Harvard Medical School, Boston, Massachusetts, and colleagues examined 1,238 patients who underwent noncardiac surgery -- including plastic, vascular, abdominal, or hernia repair surgery -- at 1 medical centre in 2000. Before their procedures, the patients were classified as high, intermediate, low, or negligible cardiac risk, and each procedure was also classified as high-, intermediate-, or low-risk. A total of 238 patients received beta-blockers perioperatively and were matched by age, sex, cardiac risk, procedure risk, smoking status, and kidney health to 408 patients who also underwent surgery at the same centre but did not receive beta-blockers. "Patients at all levels of cardiac risk who received beta-blockers had lower preoperative and intraoperative heart rates," the authors wrote. Over the 30 days after surgery, the beta-blocker group had higher rates of heart attack (2.94% vs.74%) and death (2.52% vs .25%) than those in the control group. None of the deaths occurred among patients classified as high cardiac risk. However, those in the beta-blocker group who died had significantly higher heart rates before surgery than those who didn't (86 beats per minute vs 70). "As subtle as it may be, this finding suggests that a low target preoperative, rather than intraoperative, heart rate is essential for the protective effect of beta-blockers. The relationship between preoperative heart rate and perioperative mortality stresses the importance of not only initiating but also titrating the effect of beta-blockers to an acceptable target heart rate before surgery," the authors wrote. "In summary, our study adds to the controversy regarding the optimal use of perioperative beta-blockers in patient populations at various levels of cardiac risk. Further investigations in this field with standardising of beta-blockade regimen and with monitoring of heart rate in populations at various levels of cardiac risk should be pursued." SOURCE: Archives of Surgery --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.