Treatment initiation requires careful consideration of risks and benefits to patient
04 nov 2009-- The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) recommends perioperative beta-blocker use dependent on careful consideration of the benefits and risks to an individual patient, according to an update of the 2007 guidelines outlining cardiovascular evaluation and care for non-cardiac surgery published online Nov. 2 in the Journal of the American College of Cardiology.
The authors assessed the prophylactic use of perioperative beta blockers in reducing cardiac risk based on consensus opinion after review of late-breaking and new data, with implications in the clinical practice setting. The authors discussed the 2008 PeriOperative ISchemic Evaluation (POISE) trial results, which showed more deaths in those receiving metoprolol than placebo, with sepsis or infection and stroke more common in the treatment group. The authors suggest ongoing reexamination of the need for and contraindications to beta blockers following surgery. In addition, the authors changed from Class I to Class IIa their advice for beta blockers for patients undergoing vascular surgery at high cardiac risk due to the finding of cardiac ischemia during preoperative testing. Overall, perioperative beta-blocker initiation should take into account careful consideration of the risks and benefits to patients. "In light of the POISE results, routine administration of perioperative beta blockers, particularly in higher fixed-dose regimens begun on the day of surgery, cannot be advocated. Ongoing and future studies in this area should continue to address limitations in our evidence base on this subject and provide further guidance regarding this important topic," the authors write. Several authors and reviewers reported financial relationships with pharmaceutical companies and other entities.
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