The initial clinical assessment of patients with suspected pulmonary embolism (PE) is an essential part of the current diagnostic algorithm. Standardized prediction rules can be used to determine a general pretest probability of PE that substantially improves the predictive value of diagnostic modalities such as CT angiography and ventilation‐perfusion scanning. The modified Wells criteria, which is the most broadly accepted clinical model, identify heart rate greater than 100 beats per minute as an important marker of acute PE. Beta‐blockers are a commonly used class of medications that have negative chronotropic effects and may prevent this tachycardic response. No study has evaluated the utility of tachycardia as a predictive tool for acute PE in the setting of beta‐blockade. The principal objective of this study was to demonstrate an inverse relationship between beta‐blocker use and heart rate in patients with acute PE.
This ongoing study is a retrospective cross‐sectional analysis of 130 consecutive patients to date who were diagnosed with acute PE at the Columbia University Medical Center between 2005 and 2006.
On average, the presenting heart rate was not significantly different between the beta‐blocker and control groups. The mean heart rate for patients taking a beta‐blocker was 91 beats per minute (95% CI 84‐97) compared with 96 beats per minute (95% CI 93100) for those not taking a beta‐blocker (P = .16). However, preliminary analysis shows a nonsignificant trend toward fewer tachycardic episodes (ie, at least 1 recorded heart rate of 100 beats per minute or more) among those taking a beta‐blocker. Sixty‐six of 96 patients (69%) who did not take a beta‐blocker had tachycardia at the time of presentation. In the beta‐blocker group 17 of 34 (50%) were tachycardic (OR 0.45, P = .053).
Patients with acute pulmonary embolism had similar mean heart rates regardless of beta‐blocker use. However, interim analysis suggests that patients taking a beta‐blocker were less likely to be tachycardic than those who did not take a beta‐blocker. This effect probably requires a larger sample size to demonstrate statistical significance, and subject enrollment is nearing completion.
C. Peck, none; E. Geng, none; J. Chang, none; P. Lee, Sanofi‐Aventis, Speaker's Bureau; Eisai, Speaker's Bureau.
To cite this abstract:Peck C, Geng E, Chang J, Lee P. Beta‐Blocker Use and Tachycardia in Acute Pulmonary Embolism. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 61. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/betablocker-use-and-tachycardia-in-acute-pulmonary-embolism/. Accessed April 5, 2020.