High-risk patients who are not taking beta-blockers should have an escalated beta-blocker therapy started before scheduled cardiovascular surgery, state recently updated guidelines from the American College of Cardiology and American Heart Association. Standard practices had called for initiating beta-blocker therapy on the day of the procedure, or to pump up the dose right before it in order to minimize cardiovascular surgery risks.
Data from the POISE trial (Perioperative Ischemic Evaluation), prompted the ACC/AHA to revisit the issue, according to Kirsten E. Fleischmann, MD, who chaired the group that drafted the update. Fleischmann said the new guidelines do not alter the current recommendation to continue beta-blockers perioperatively in those patients who are already receiving them. She said 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.”
In the POISE trial, patients taking beta-blockers had a lower risk of perioperative myocardial infarction and/or primary cardiac event, but they had a higher risk of stroke and overall mortality. The work group also agreed that beta-blockers were reasonable to consider in the following situations:
- 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 who undergo vascular surgery
Journal of the American College of Cardiology http://content.onlinejacc.org/cgi/content/full/j.jacc.2009.07.010v1