Cardiovascular Disease |

Do Beta-Blockers Increase Perioperative Cardiac Morbidity?

Pratik Dalal, MBBS; Divyashree Varma, MBBS; Housam Hegazy, MD
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SUNY-Upstate Medical University Hospital, Syracuse, NY

Chest. 2013;144(4_MeetingAbstracts):166A. doi:10.1378/chest.1704913
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SESSION TITLE: Cardiovascular Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Aim of this study was to assess the risks and benefits of beta-blockers during the perioperative period in patients undergoing non-cardiac surgery.

METHODS: We performed a retrospective cohort analysis of 755 patients in a single university based centre. Patients who had undergone non cardiac surgery were picked at random and sub-classified according to gender, ethnicity, risk of surgery, and whether beta-blockers were used in the perioperative setting. Utilizing the logistic regression model six different outcomes were investigated in this study: all cause mortality, ACS, significant arrhythmias, cardiac event related death, bradycardia and decompensated heart failure. Three variables were used to predict these outcomes: beta-blocker administration, RCRI score, and risk of surgery.

RESULTS: Beta-blocker use was found to increase the odds of having an acute coronary event by a factor of 21.76 (CI: 2.85-?). Decompensated heart failure was also seen to increase by an odds ratio of 4.50 (CI: 1.29-15.70). Surprisingly, risk of arrhythmias was also seen to increase (Odds ratio-2.96; CI: 1.08-4.80). However, due to a small event rate, statistical correctional formulas had to be utilized to stabilize results.

CONCLUSIONS: Our study suggests that beta-blockers may actually increase the risk of having an adverse cardiac event during the perioperative period. Risk of decompensated heart failure and arrhythmias also seems to increase, but to a lesser degree.

CLINICAL IMPLICATIONS: These results becomes especially important in view of the fact that beta-blcokers are currently recommended by the American College of Cardiology/American Heart Association (ACC/AHA) 2011 guidelines regarding peri-operative cardiac risk stratification and management. Benefit may be limited only to the high risk category, including current chronic users and those who would benefit from beta-blocker use by virtue of cardiac pathology, irrespective of surgery.

DISCLOSURE: The following authors have nothing to disclose: Pratik Dalal, Divyashree Varma, Housam Hegazy

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