Key result
A survey of perioperative practitioners revealed highly variable timing of ACEi/ARB cessation, with 32% (n=62) continuing them throughout the perioperative period, and frequent practice misalignment.
Why the study?
What is the variability in perioperative management of ACEi/ARBs among perioperative medicine practitioners?
Cross-Sectional
What is the variability in perioperative management of ACEi/ARBs among perioperative medicine practitioners?
There is significant inconsistency in the perioperative management of ACEi/ARBs among clinicians, highlighting the need for randomized controlled trials to guide practice.
Answers are grounded in this paper and cite their sources.
Variable perioperative ACEi/ARB cessation indicates practice uncertainty; leaves open optimal timing and supports RCTs to standardize care.
BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are the most commonly prescribed antihypertensive medications in higher-risk surgical patients. However, there is no clinical consensus on their use in the perioperative period, in part, due to an inconsistent evidence-base. To help inform the design of a large multi-centre randomized controlled trial (ISRCTN17251494), we undertook a questionnaire-based survey exploring variability in ACEi/ARB prescribing in perioperative practice. METHODS: The online survey included perioperative scenarios to examine how consistent respondents were with their stated routine preoperative practice. Clinicians with an academic interest in perioperative medicine were primarily targeted between July and September 2017. STROBE guidelines for observational research and ANZCA Trials Group Survey Reporting recommendations were adhered to. RESULTS: = 62; 32%) throughout the perioperative period. However, timing of preoperative cessation was highly variable, and rarely influenced by the pharmacokinetics of individual ACE-i/ARBs. Respondents' stated routine practice was frequently misaligned with their management of common pre- and postoperative scenarios involving continuation or restarting ACE-i/ARBs. DISCUSSION: This survey highlights many inconsistencies amongst clinicians' practice in perioperative ACE-i/ARB management. Studies designed to reveal an enhanced understanding of perioperative mechanisms at play, coupled with randomised controlled trials, are required to rationally inform the clinical management of ACE-i/ARBs in patients most at risk of postoperative morbidity.
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Walker et al. (2018) conducted a cross-sectional in Perioperative ACEi/ARB management. Perioperative ACEi/ARB prescribing practices was evaluated on Variability in ACEi/ARB prescribing in perioperative practice. A survey of perioperative practitioners revealed highly variable timing of ACEi/ARB cessation, with 32% (n=62) continuing them throughout the perioperative period, and frequent practice misalignment.
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