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Randomized Controlled Trial
. 2015 Oct;170(4):812-820.e6.
doi: 10.1016/j.ahj.2015.06.028. Epub 2015 Jul 26.

Patterns of β-blocker initiation in patients undergoing intermediate to high-risk noncardiac surgery

Elisabetta Patorno  1 , Shirley V Wang  2 , Sebastian Schneeweiss  3 , Jun Liu  4 , Brian T Bateman  5
Affiliations
Randomized Controlled Trial

Patterns of β-blocker initiation in patients undergoing intermediate to high-risk noncardiac surgery

Elisabetta Patorno et al. Am Heart J. 2015 Oct.

Abstract

Background: Based on 2 small randomized controlled trials (RCTs) from the 1990s, β-blockers were promoted to prevent perioperative cardiac events in patients undergoing noncardiac surgery. In 2008, a large RCT (POISE trial) showed an increased mortality risk associated with perioperative β-blockade, raising concerns about an extensive β-Blocker use.

Objectives: The objective of the study is to examine patterns of β-Blocker initiation among patients undergoing noncardiac elective surgery in the US.

Methods: From a large, nationwide US health care insurer, we identified patients ≥18 years old who underwent moderate- to high-risk noncardiac elective surgery between 2003 and 2012 and initiated a β-Blocker within 30 days before surgery. We evaluated temporal trends and assessed the impact of the POISE trial on perioperative β-Blocker initiation. We also evaluated patient characteristics and examined the effect of temporal proximity to surgery on the likelihood of β-Blocker initiation.

Results: Of 499,752 patients undergoing surgery, 9,014 (18 per 1,000 patients) initiated a β-Blocker. β-Blocker initiation increased from 12 per 1,000 patients in 2003 to 23 before POISE, after which it decreased to 14 by December 2012 (P = .0001). β-Blocker initiation remained relatively high among patients undergoing vascular surgery or with Revised Cardiac Risk Index score ≥ 2. Proximity to surgery was highly predictive of β-Blocker initiation (odds ratio 3.34, 95% CI 3.17-3.51).

Conclusions: After a period of a rapidly increasing trend, perioperative β-Blocker initiation decreased sharply in the second half of 2008 and continued to decrease afterwards. β-Blocker initiation remained relatively high in patients with Revised Cardiac Risk Index score ≥2 and in those undergoing major vascular surgery.

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Figures

Figure 1
Figure 1
Flowchart of study cohort.
Figure 2
Figure 2
Temporal trends in β-blocker initiation within 30 days of surgery, August 2003 to December 2012.
See this image and copyright information in PMC

References

    1. Devereaux PJ, Chan MT, Alonso-Coello P, et al. Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA 2012;307:2295–304. - PubMed
    1. Devereaux PJ, Goldman L, Cook DJ, et al. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ 2005;173:627–34. - PMC - PubMed
    1. Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977;297:845–50. - PubMed
    1. Zaman AG, Helft G, Worthley SG, et al. The role of plaque rupture and thrombosis in coronary artery disease. Atherosclerosis 2000;149:251–66. - PubMed
    1. Warltier DC, Pagel PS, Kersten JR. Approaches to the prevention of perioperative myocardial ischemia. Anesthesiology 2000;92:253–9. - PubMed

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