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Studies unclear on role of pre-surgery beta blockers

Date:
February 23, 2010
Source:
University of Michigan Health System
Summary:
It's not unusual for patients to suffer a cardiac event before surgery, and in theory, beta blockers will reduce the risk by relieving stress on the heart. But the one-size-fits-all approach can harm some patients, and heart specialists report that clinical studies have been unclear about who should get perioperative beta blockers and at what dosage.

In a commentary appearing in the Journal of the American Medical Association, heart specialists at the University of Michigan Health System make a plea for clarity on the best approach for prescribing beta blockers before surgery.

It's not unusual for patients to suffer a cardiac event during surgery, and in theory, beta blockers will reduce the risk by slowing the heartbeat, reducing blood vessel constriction, lowering demand of the heart muscle for oxygen, and generally relieving stress on the heart. However, a one-size-fits-all approach for prescribing beta blockers can harm patients at low-risk for having a heart attack.

Future clinical studies using clear models of dose, duration and implementation could provide answers for doctors about the role of pre-surgery beta blockers, according to the U-M commentary.

Because of important design, treatment and analytical variations, previous clinical trials are hard to interpret.

For instance, the 2001 DECREASE I study included high-risk patients with known coronary blockages who faced high risk surgery. Importantly, the beta blockers were given based on individual heart rate and blood pressure. In contrast, the recent 2008's POISE study included a mixed group of patients undergoing major non-cardiac surgery and took a long-acting drug.

Given these important differences, the studies have not offered clear answers about who should get beta blockers, what the starting dose should be and how doses should be adjusted for patients.

"The time has come for clarity across perioperative beta blocker studies," the U-M authors write.

Authors: Vineet Chopra, M.D., a hospitalist at U-M Health System and clinical assistant professor of internal medicine at the U-M Medical School and Kim A. Eagle, M.D., director of the U-M Cardiovascular Center and the Albion Walter Hewlett Professor of Internal Medicine.


Story Source:

The above story is based on materials provided by University of Michigan Health System. Note: Materials may be edited for content and length.


Journal Reference:

  1. Vineet Chopra; Kim A. Eagle. Perioperative β-Blockers for Cardiac Risk Reduction: Time for Clarity. JAMA, 2010; 303 (6): 551-552 [link]

Cite This Page:

University of Michigan Health System. "Studies unclear on role of pre-surgery beta blockers." ScienceDaily. ScienceDaily, 23 February 2010. <www.sciencedaily.com/releases/2010/02/100209183135.htm>.
University of Michigan Health System. (2010, February 23). Studies unclear on role of pre-surgery beta blockers. ScienceDaily. Retrieved August 20, 2014 from www.sciencedaily.com/releases/2010/02/100209183135.htm
University of Michigan Health System. "Studies unclear on role of pre-surgery beta blockers." ScienceDaily. www.sciencedaily.com/releases/2010/02/100209183135.htm (accessed August 20, 2014).

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