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Perioperative Use of Beta-Blockers in Noncardiac Surgery Questioned

Findings from a Lancet meta-analysis raise questions about the use of beta-blockers in intermediate- or high-risk patients undergoing noncardiac surgery, as current guidelines recommend.

Researchers pooled data from 33 randomized trials comparing beta-blockers with control therapy among some 12,300 surgical patients. In analyses of 30-day outcomes, beta-blockers were associated with:

• similar risks for all-cause mortality, cardiovascular mortality, and heart failure, compared with control therapy;
  
• reduced risks for myocardial ischemia (5% vs. 10% with control) and nonfatal MI (3% vs. 5%);
  
• increased risks for nonfatal strokes (0.7% vs. 0.3%), bradycardia, and hypotension.
  

The authors conclude that beta-blockers have "no clear benefit" in noncardiac surgery.

However, in Journal Watch Cardiology, Beat J. Meyer says the meta-analysis was "confounded by ... methodologic weaknesses." He concludes that the benefits of treatment still outweigh the risks when the "type and dose of beta-blocker are carefully selected according to individual patients' risk profiles" and "patients are properly monitored for perioperative hypotension and bradycardia."

LINK(S):

Lancet article (Free PDF)

Lancet comment (Free PDF)

American College of Cardiology/American Heart Association guidelines on perioperative management of patients undergoing noncardiac surgery (Free)

Journal Watch Cardiology summary (Subscription required)

Published in Physician's First Watch November 12, 2008