Perioperative β-blocker use in non-cardiac surgery increases mortality
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Reactions 1466, p3 - 24 Aug 2013 Perioperative β-blocker use in non- cardiac surgery increases mortality European Society of Cardiology (ESC) guidelines currently recommend perioperative use of β-blockers in non-cardiac surgery based on the DECREASE studies, which found that perioperative β-blocker use in that setting decreased mortality. However, the DECREASE studies have subsequently been discredited, and a meta- analysis investigating the effect of perioperative β- blocker use on mortality after non-cardiac surgery has found that recipients of β-blockers had a 27% increased risk of all-cause mortality at 30 days. The analysis included randomised controlled trials comparing preoperative initiation of β-blockers with placebo in adult patients undergoing non-cardiac surgery. Nine studies investigating 10 529 patients were included in the analysis; the DECREASE studies were excluded. The primary endpoint was all-cause mortality at 30 days or hospital discharge. Versus placebo, perioperative initiation of β-blockers resulted in an increase in mortality (risk ratio 1.27, 95% CI 1.01, 1.60), stroke (1.73; 1.00, 2.99) and hypotensive episodes (1.51; 1.37, 1.67), and a decrease in non-fatal myocardial infarction (0.73; 0.61, 0.88). The authors conclude that based on their current results, the ESC recommendation for perioperative β- blocker use in non-cardiac surgery should be retracted. Bouri S, et al. Meta-analysis of secure randomised controlled trials of beta- blockade to prevent perioperative death in non-cardiac surgery. Heart : [9 pages], 31 Jul 2013. Available from: URL: http:// dx.doi.org/10.1136/heartjnl-2013-304262 803091257 1 Reactions 24 Aug 2013 No. 1466 0114-9954/13/1466-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Transcript of Perioperative β-blocker use in non-cardiac surgery increases mortality
Reactions 1466, p3 - 24 Aug 2013
Perioperative β-blocker use in non-cardiac surgery increases mortality
European Society of Cardiology (ESC) guidelinescurrently recommend perioperative use of β-blockers innon-cardiac surgery based on the DECREASE studies,which found that perioperative β-blocker use in thatsetting decreased mortality. However, the DECREASEstudies have subsequently been discredited, and a meta-analysis investigating the effect of perioperative β-blocker use on mortality after non-cardiac surgery hasfound that recipients of β-blockers had a 27% increasedrisk of all-cause mortality at 30 days.
The analysis included randomised controlled trialscomparing preoperative initiation of β-blockers withplacebo in adult patients undergoing non-cardiacsurgery. Nine studies investigating 10 529 patients wereincluded in the analysis; the DECREASE studies wereexcluded. The primary endpoint was all-cause mortalityat 30 days or hospital discharge.
Versus placebo, perioperative initiation of β-blockersresulted in an increase in mortality (risk ratio 1.27,95% CI 1.01, 1.60), stroke (1.73; 1.00, 2.99) andhypotensive episodes (1.51; 1.37, 1.67), and a decreasein non-fatal myocardial infarction (0.73; 0.61, 0.88).
The authors conclude that based on their currentresults, the ESC recommendation for perioperative β-blocker use in non-cardiac surgery should be retracted.Bouri S, et al. Meta-analysis of secure randomised controlled trials of beta-blockade to prevent perioperative death in non-cardiac surgery. Heart : [9 pages],31 Jul 2013. Available from: URL: http://dx.doi.org/10.1136/heartjnl-2013-304262 803091257
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Reactions 24 Aug 2013 No. 14660114-9954/13/1466-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
