Studies examining the effect of perioperative β‐blockade on cardiac events have yielded conflicting results. This discrepancy is in part a result of differences in degrees of β‐blockade as assessed by heart rate (HR). Complications from β‐blockers as illustrated by the recently presented POISE trial are also likely related to the degree of β‐blockade. We sought to determine what degree of HR reduction was achieved with perioperative β‐blockade as applied in practice and the rate of adverse effects
This was a retrospective chart review. Patients who underwent major vascular surgery in the first 3 months of 2002 and received perioperative β‐blockers were included. Charts were reviewed for known coronary artery disease (CAD) and other revised cardiac risk index (RCRI) variables. HRs were recorded from the morning of surgery and postoperative days (PODs) 1‐4. The goal resting HR was defined as < 65. In addition to the resting HR, an average daily HR was calculated, with a goal < 80. The occurrence of complications including congestive heart failure, bronchospasm, bradycardia, and hypotension was noted.
Fifty‐four patients were included. Their mean age was 71 years, 46% were female, and 80% had known CAD. Sixty‐three percent had 3 or more RCRI risk factors, 28% had 2, and 9% had 1. Thirty‐five percent were followed by a medical consultant. The (3‐blocker dose was unchanged in 65% of patients during the study period. The mean HR on the day of surgery was 69, with 44% achieving the goal resting HR. The mean resting HR on PODs 1‐4 was 78, 80, 79, and 77, respectively, with 43% of patients reaching the goal resting HR on any POD. For all PODs, the goal resting HR was observed in only 18% of measurements. An average daily HR of < 80 on PODs 1‐4 was achieved by 52%, 49%, 56%, and 71%, respectively. Eighty percent of patients had an average HR < 80 on at least 1 day. For all patient‐days, this was achieved in 57%. Achieving the goal resting HR was associated with achieving an average HR < 80 for all 4 PODs (P < .01). There was no significant association between achieving the lower HR and occurrence of the combined complication end point, although rates were high in both groups (56% vs. 68%, P = .39).
The low HR that may be necessary to reduce perioperative cardiac events is not routinely achieved. Complications of therapy are relatively common. Careful protocol use and more physician involvement in dosing of the medication are likely necessary if β‐blockers are to be used as a safe and effective risk‐reduction strategy.
C. Gutjahr, none; J. Quartarolo, none.
To cite this abstract:Gutjahr C, Quartarolo J. Perioperative β‐Blockade in Clinic Practice. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 26. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/perioperative-blockade-in-clinic-practice/. Accessed May 26, 2019.