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Beta-blocker exposure improved nonvascular surgery patient outcomes

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Patients at cardiac risk who received beta-blockers on the day of or following noncardiac, nonvascular surgery had significantly lower rates of 30-day mortality and cardiac illness, according to study results published in JAMA.

Researchers conducted a retrospective cohort analysis to examine the association of early perioperative beta-blocker exposure with all-cause mortality and cardiac morbidity in patients undergoing noncardiac surgery. The study included 136,745 patients who were 1:1 matched on propensity scores (37,805 matched pairs). Patients were treated at 104 Veterans Affairs medical centers from January 2005 to August 2010.

 

Martin J. London

Overall, 40.3% of patients were exposed to beta-blockers on postoperative day 0 or 1. Thirty-three percent had an active outpatient prescription for beta-blockers within 7 days of surgery.

Beta-blocker exposure was higher in 66.7% of 13,863 patients who underwent vascular surgery compared with the 37.4% of 122,822 patients who underwent nonvascular surgery (P<.001), according to the data.

The rate of beta-blocker exposure increased as Revised Cardiac Risk Index factors increased. For example, 25.3% of patients with no Revised Cardiac Risk Index factors used beta-blockers compared with 71.3% of patients with four or more factors (P<.001).

Overall, 1.1% of patients died and 0.9% experienced cardiac morbidity during the study.

Analysis of the propensity matched cohort revealed that beta-blocker exposure was associated with lower mortality (RR=0.73; 95% CI, 0.65-0.83). The researchers calculated a number needed to treat of 241. Additionally, stratified by cumulative numbers of Revised Cardiac Risk Index factors, the researchers found a significant association between beta-blocker exposure and lower mortality among patients with four or more factors (RR=0.4; 95% CI, 0.25-0.73), three factors (RR=0.54; 95% CI, 0.39-0.73) or two factors (RR=0.63; 95% CI, 0.5-0.8).

Rates of nonfatal Q-wave infarction or cardiac arrest were also lower after beta-blocker exposure.

The researchers noted that these associations were limited to patients who underwent nonvascular surgery.

“Our findings support use of a cumulative number of Revised Cardiac Risk Index predictors in decision making regarding institution and continuation of perioperative beta-blockade,” Martin J. London, MD, of the department of anesthesia and perioperative care, US Department of Veterans Affairs Medical Center, and colleagues wrote. “A multicenter randomized trial involving patients at a low to intermediate risk by these factors would be of interest to validate these observational findings.”

For more information:

London MJ. JAMA. 2013;309:1704-1713.

Disclosure: London reports receiving a grant from the Anesthesia Patient Safety Foundation. Another researcher reports grants pending from Anthera, Resverlogix, Roche and Sanofi. All other researchers report no relevant financial disclosures.