ACC/AHA revised guidelines for the perioperative use of beta blockers to minimize cardiac risk

Nov 02, 2009

Cardiac complications around the time of noncardiac surgery are relatively common and can be serious. The American College of Cardiology (ACC) and the American Heart Association (AHA) today release a Focused Update to the Practice Guidelines based on new clinical trial data that summarizes and sheds light on the risks and benefits of using beta blockers to reduce cardiac events during noncardiac surgeries, and provides specific recommendations about which patients will likely benefit and in which patients there is not enough evidence to recommend their use.

"Any surgery, particularly a high-risk procedure, is a stress on the heart, especially for those with underlying circulation problems or other ," says Kirsten E. Fleischmann, M.D., M.P.H., chair of the 2009 writing group that reviewed the latest evidence on the perioperative use of . "In general, the higher the risk from a cardiovascular standpoint, the more likely a patient will benefit from beta blockers. However, newer data from the POISE [Perioperative Ischemic Evaluation] trial suggest that starting higher doses of beta blockers acutely on the day of surgery is associated with risk as well, so careful patient selection, dose adjustment and monitoring throughout the perioperative period is key."

More than 30 million noncardiac surgeries are performed in the United States each year. Cardiac problems around the time of surgery are a major cause of complications and death in these patients, prolonging hospitalizations and increasing costs. Beta blockers are designed to help protect against heart attack around the time of surgery by lowering heart rate and helping to block the effects of on the heart.

The recommendation to continue beta blockers perioperatively in those patients who are already receiving them remains current since the initial 2007 guidelines were published. The workgroup advises beta blockers are reasonable to consider in:

  • Patients at high risk for heart attacks or other cardiac complications because of abnormal stress test results or known coronary artery disease who undergo vascular surgery
  • High risk patients undergoing intermediate risk surgery or in those with multiple risk factors for complications (e.g., diabetes, a history of heart failure, significant kidney disease) who undergo vascular surgery
However, authors caution that when beta blockers are started in patients not yet taking them, the medication should be initiated well before the procedure and titrated up as blood pressure and heart rate allow.

"We recommend beta blockers be started well in advance of surgery and not at higher doses right off the bat," says Dr. Fleischmann. "These updated guidelines are intended to provide guidance for the appropriate use of beta blockers to help reduce the risk of cardiac complications. Physicians must be vigilant in assessing patients' cardiac risk and weighing this against potential side effects of the therapy."

According to the authors, the usefulness of beta blockers remains uncertain in lower-risk patients or in those undergoing lower-risk surgeries (e.g., percutaneous or endovascular procedures), and requires careful consideration of the risks and benefits.

The guidelines do not advocate for routine administration of beta blockers, particularly in higher fixed-dose regimens, begun on the day of surgery based on data from the POISE study. While there was a reduction in perioperative myocardial infarction and primary among study participants, the use of beta blockers was also associated with higher rates of stroke and overall mortality. Beta blockers should not be used when contraindications exist.

More information: Full text of the Focused Update will be published in the November 24, 2009, issue of the Journal of the American College of Cardiology and the November 24, 2009, Circulation, and will be posted on the ACC (www.acc.org) and AHA (www.americanheart.org) Web sites.

Source: American College of Cardiology (news : web)

Explore further: Exploring 3-D printing to make organs for transplants

add to favorites email to friend print save as pdf

Related Stories

Heart failure treated 'in the brain'

Mar 25, 2008

Beta-blockers heal the heart via the brain when administered during heart failure, according to a new study by UCL (University College London). Up to now, it was thought that beta-blockers work directly on the heart, but ...

Beta-blockers given the boot in Britain

Jun 28, 2006

British doctors are being advised not to prescribe beta-blockers and to ease most current users off them and onto new treatment for high blood pressure.

Two beta blockers found to also protect heart tissue

Sep 15, 2008

(PhysOrg.com) -- A newly discovered chemical pathway that helps protect heart tissue can be stimulated by two of 20 common beta-blockers, drugs that are prescribed to millions of patients who have experienced heart failure.

Recommended for you

Exploring 3-D printing to make organs for transplants

13 hours ago

Printing whole new organs for transplants sounds like something out of a sci-fi movie, but the real-life budding technology could one day make actual kidneys, livers, hearts and other organs for patients ...

High frequency of potential entrapment gaps in hospital beds

15 hours ago

A survey of beds within a large teaching hospital in Ireland has shown than many of them did not comply with dimensional standards put in place to minimise the risk of entrapment. The report, published online in the journal ...

Key element of CPR missing from guidelines

Jul 29, 2014

Removing the head tilt/chin lift component of rescue breaths from the latest cardiopulmonary resuscitation (CPR) guidelines could be a mistake, according to Queen's University professor Anthony Ho.

Burnout impacts transplant surgeons (w/ Video)

Jul 28, 2014

Despite saving thousands of lives yearly, nearly half of organ transplant surgeons report a low sense of personal accomplishment and 40% feel emotionally exhausted, according to a new national study on transplant surgeon ...

User comments : 0