Chronic β Blockade Is Associated with a Better Outcome after Elective Noncardiac Surgery than Acute β Blockade
Why the study?
Does acute beta-blockade compared to chronic beta-blockade increase the risk of major acute cardiac outcomes in patients undergoing elective noncardiac surgery?
Population
10,691 consecutive patients undergoing elective noncardiac surgery between April 1, 2008, and April 30, 2010.
Comparison
Acute beta-blocker therapy vs Chronic beta-blocker therapy before surgery
Design
Cohort
Follow-up
perioperative
Authors
Discussion
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Member takes
Implication
Acute beta-blockade was associated with higher cardiac risk than chronic use; leaves open whether perioperative initiation should be avoided pending randomized data.
Structured PICO
Does acute beta-blockade compared to chronic beta-blockade increase the risk of major acute cardiac outcomes in patients undergoing elective noncardiac surgery?
P
Population
10,691 consecutive patients undergoing elective noncardiac surgery between April 1, 2008, and April 30, 2010 (propensity-matched cohort of 301 pairs).
I
Intervention
Acute beta-blocker therapy (initiated within the first 2 days after surgery)
C
Comparator
Chronic beta-blocker therapy before surgery
O
Outcome
Composite of myocardial infarction, nonfatal cardiac arrest, and perioperative mortalitycomposite
Acute perioperative beta-blockade is associated with significantly worse cardiac outcomes compared to chronic beta-blockade in patients undergoing elective noncardiac surgery.
Limitations
- Observational design requiring validation in a larger prospective trial
Cite This Study
Ellenberger et al. (2011) studied this question.