Beta blockade aids select surgery patients

By Lynda Williams, Senior medwireNews Reporter

Research supports the use of perioperative beta blockade in patients with cardiovascular risk factors undergoing nonvascular procedures, finding this treatment to significantly improve short-term survival.

Overall, 1.1% of the 136,745 US patients undergoing surgery at a Veterans Affairs (VA) medical center between January 2005 and August 2010 died within 30 days, and 0.9% experienced cardiac arrest or Q-wave myocardial infarction.

Mortality was significantly lower among the 40.3% of patients who received beta blockade on the day of surgery or the day after than patients not given the treatment, with a relative risk (RR) of 0.73 and a number needed to treat (NNT) to prevent one death of 241.

Furthermore, propensity-matched analysis revealed that patients with two, three, or at least four Revised Cardiac Risk Index factors who were given beta blockers had significantly lower rates of 30-day all-cause mortality than controls, with corresponding RR of 0.63, 0.54, and 0.40, and NTT of 105, 41, and 18, respectively.

But this benefit was found only for patients undergoing noncardiac, nonvascular surgery, report Martin London (San Francisco VA Medical Center, California, USA) and co-authors in JAMA.

Similarly, beta blockade was significantly associated with a reduced risk for cardiac arrest and Q-wave myocardial infarction for patients undergoing noncardiac, nonvascular procedures (RR=0.67, NNT=339), but not vascular surgery patients.

London et al note that use of perioperative beta blockade is controversial and currently only recommended for patients already taking the medication, with some suggestion of declining use due to safety or efficacy concerns.

They found that receipt of perioperative blockade was significantly predicted by the presence of cardiac disease, rising from 25.3% of patients with no Revised Cardiac Risk Index factors to 71.3% of patients with four or more risk factors. Likewise, beta blockade was significantly more common in the 66.7% of vascular surgery patients than the 37.4% of nonvascular patients.

"Although assessment of cumulative number of Revised Cardiac Risk Index predictors might be helpful to clinicians in deciding whether to use perioperative beta-blockade, the current findings highlight a need for a randomized multicenter trial of perioperative beta-blockade in low- to intermediate-risk patients scheduled for noncardiac surgery," the researchers conclude.

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