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Beta-blockade did not prevent perioperative clinical outcomes

Issue: January 2009

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The use of beta-blockers prior to noncardiac surgery did not reduce the risk for all-cause mortality, cardiovascular mortality or heart failure, results from a meta-analysis indicated.

Researchers searched through PubMed and Embase for studies of beta-blockers used for perioperative care. The researchers narrowed the field of 112 studies down to 33 that met inclusion criteria. The studies included 12,036 patients having noncardiac surgery, 6,311 (51%) of whom were randomly assigned to a beta-blocker group and 5,995 (49%) of whom were assigned to a control group. According to the results of the meta-analysis, beta-blocker therapy was not associated with a reduction in the risk for all-cause mortality (P=.120), CV mortality (P=.358) or HF (P=128). The researchers also reported that beta-blocker therapy was associated with a 35% decreased risk for nonfatal MI (P<.0001) and a 64% decreased risk for myocardial ischemia (P<.0001) at the expense of a 116% increased risk for nonfatal stroke (P=128).

Beta-blockers were also associated with a high risk for perioperative bradycardia (OR=3.13; 95% CI, 2.51-3.92), perioperative bradycardia requiring treatment (OR=2.74; 95% CI, 2.29-3.29), perioperative hypotension (OR=1.69; 95% CI, 1.39-2.05) and perioperative hypotension requiring treatment (OR=1.62; 95% CI, 1.44-1.82) for the entire cohort.

“In view of the increased risk for stroke, bradycardia and hypotension, beta-blockers should not be used for perioperative treatment of patients undergoing noncardiac surgery unless patients are already taking them for clinically indicated reasons,” the researchers wrote. “The American College of Cardiology/American Heart Association guideline committee should soften their stance on perioperative beta blockade until evidence shows a clear benefit. Use of perioperative beta blockade as a performance measure, when there is no robust evidence for improved outcome, is inappropriate.”

For more information:

• Lancet. 2008;doi:10.1016/S0140-6736(08)61560-3.