In the Forum
Beta-Blockers Protect Heart after Major Surgery
Volume: 12 (31/07/2005)
The first observational study on how beta-blockers administered before and after major non-cardiac surgery affect people with varying heart risk factors has been recently completed. The researchers found that perioperative beta-blocker treatment helped reduce risk of in-hospital death among high-risk, but not low-risk, patients undergoing non-cardiac surgery. The findings were published in the latest issue of the "New England Journal of Medicine". Beta-blockers are drugs which decrease the force of the heart's pumping action; they are used to treat high blood pressure and other heart problems, as well as to prevent complications in heart attack survivors. 1 in 10 patients out of the 20 million that undergo surgery each
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year in various hospitals throughout the United States can be expected to have a complication within the following 30 days. For the patients who suffer surgery-related myocardial infarction, there are few effective prevention measures. There have been two large randomized trials in the past decade that found that beta-blockers can decrease the incidence of myocardial infarction and death after non-cardiac surgery; these drugs are now widely advocated because they appear efficacious, are inexpensive, and have few risks. However, there are other two recent randomized trials which report no benefit from perioperative beta-blocker therapy.
This retrospective study looks at patients who underwent major non-cardiac surgery at 329 hospitals in the US, between 2000-2001 and analyses differences between patients who received beta-blockers before and after surgery and those who did not, comparing in-hospital mortality.
Of the 782,969 cases observed, 663,635 (85 percent) had no recorded contraindications to beta-blockers, 122,338 of whom (18 percent) received beta-blocker therapy during the first two hospital days. Their median age was 62 years.
Researches calculated a Revised Cardiac Risk Index (RCRI) score for each patient, assigning one point for each of the following risk factors: high-risk surgery, ischemic heart disease, cerebro-vascular disease, renal insufficiency, and diabetes mellitus.
They found that the relationship between beta-blocker therapy and risk of death varied directly with cardiac risk. Among high-risk patients (RCRI score of 3 or greater), beta-blocker therapy was associated with clear and clinically significant reductions in mortality, among the patients with a RCRI score of 2, it was found to be beneficial, while among the 580,665 patients with an RCRI score of 0 or 1, treatment produced no benefit and possible harm.
Thus, the study supports the idea that beta blockers should continue to be given to high-risk patients who have surgery. Researchers conclude that "until the results of large randomized trials become available, ongoing national efforts to increase patient safety by increasing the perioperative use of beta-blockers among high-risk patients appear warranted."
This retrospective study looks at patients who underwent major non-cardiac surgery at 329 hospitals in the US, between 2000-2001 and analyses differences between patients who received beta-blockers before and after surgery and those who did not, comparing in-hospital mortality.
Of the 782,969 cases observed, 663,635 (85 percent) had no recorded contraindications to beta-blockers, 122,338 of whom (18 percent) received beta-blocker therapy during the first two hospital days. Their median age was 62 years.
Researches calculated a Revised Cardiac Risk Index (RCRI) score for each patient, assigning one point for each of the following risk factors: high-risk surgery, ischemic heart disease, cerebro-vascular disease, renal insufficiency, and diabetes mellitus.
They found that the relationship between beta-blocker therapy and risk of death varied directly with cardiac risk. Among high-risk patients (RCRI score of 3 or greater), beta-blocker therapy was associated with clear and clinically significant reductions in mortality, among the patients with a RCRI score of 2, it was found to be beneficial, while among the 580,665 patients with an RCRI score of 0 or 1, treatment produced no benefit and possible harm.
Thus, the study supports the idea that beta blockers should continue to be given to high-risk patients who have surgery. Researchers conclude that "until the results of large randomized trials become available, ongoing national efforts to increase patient safety by increasing the perioperative use of beta-blockers among high-risk patients appear warranted."
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