Featured Research

from universities, journals, and other organizations

Revised Guidelines For Perioperative Use Of Beta Blockers To Minimize Cardiac Risk

Date:
November 2, 2009
Source:
American College of Cardiology
Summary:
Cardiac complications around the time of noncardiac surgery are relatively common and can be serious. The American College of Cardiology and the American Heart Association have released a Focused Update to the Practice Guidelines based on new clinical trial data.

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 cardiovascular risk factors," 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 beta blockers. "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 stress hormones 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 cardiac events 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.

This ACCF/AHA update was developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine, and Society for Vascular Surgery.

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.


Story Source:

The above story is based on materials provided by American College of Cardiology. Note: Materials may be edited for content and length.


Cite This Page:

American College of Cardiology. "Revised Guidelines For Perioperative Use Of Beta Blockers To Minimize Cardiac Risk." ScienceDaily. ScienceDaily, 2 November 2009. <www.sciencedaily.com/releases/2009/11/091102171219.htm>.
American College of Cardiology. (2009, November 2). Revised Guidelines For Perioperative Use Of Beta Blockers To Minimize Cardiac Risk. ScienceDaily. Retrieved September 3, 2014 from www.sciencedaily.com/releases/2009/11/091102171219.htm
American College of Cardiology. "Revised Guidelines For Perioperative Use Of Beta Blockers To Minimize Cardiac Risk." ScienceDaily. www.sciencedaily.com/releases/2009/11/091102171219.htm (accessed September 3, 2014).

Share This



More Health & Medicine News

Wednesday, September 3, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Snack Attack: Study Says Action Movies Make You Snack More

Snack Attack: Study Says Action Movies Make You Snack More

Newsy (Sep. 2, 2014) You're more likely to gain weight while watching action flicks than you are watching other types of programming, says a new study published in JAMA. Video provided by Newsy
Powered by NewsLook.com
U.N. Says Ebola Travel Restrictions Will Cause Food Shortage

U.N. Says Ebola Travel Restrictions Will Cause Food Shortage

Newsy (Sep. 2, 2014) The U.N. says the problem is two-fold — quarantine zones and travel restrictions are limiting the movement of both people and food. Video provided by Newsy
Powered by NewsLook.com
Doctors Fear They're Losing Battle Against Ebola

Doctors Fear They're Losing Battle Against Ebola

AP (Sep. 2, 2014) As a third American missionary is confirmed to have contracted Ebola in Liberia, doctors on the ground in West Africa fear they're losing the battle against the outbreak. (Sept. 2) Video provided by AP
Powered by NewsLook.com
Tech Giants Bet on 3D Headsets for Gaming, Healthcare

Tech Giants Bet on 3D Headsets for Gaming, Healthcare

AFP (Sep. 2, 2014) When Facebook acquired the virtual reality hardware developer Oculus VR in March for $2 billion, CEO Mark Zuckerberg hailed the firm's technology as "a new communication platform." Duration: 02:24 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins