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VNA of Care New England

Peri-Noncardiac Op Exposure to β-Blockers Improves Outcome

Exposure tied to lower mortality for patients with two or more Revised Cardiac Risk Index factors
TUESDAY, April 23 (HealthDay News) -- For patients undergoing major noncardiac surgery with two or more Revised Cardiac Risk Index factors, early exposure to β-blockers is associated with improved 30-day postoperative outcome, according to research published in the April 24 issue of the Journal of the American Medical Association.
Martin J. London, M.D., from the University of California in San Francisco, and colleagues conducted a retrospective cohort analysis to evaluate early perioperative exposure to β-blockers on the day of or following major noncardiac surgery for 136,745 patients. A total of 37,805 propensity score-matched pairs were identified from 104 Veterans Affairs medical centers.
The researchers found that exposure to β-blockers increased with an increase in Revised Cardiac Risk Index factors (25.3 percent for those with no risk versus 71.3 percent for those with four or more risk factors). Exposure correlated with lower mortality in the propensity-matched cohort (relative risk, 0.73). β-blocker exposure correlated with significantly lower mortality for patients with two, three, or four Revised Cardiac Risk Index factors (relative risk, 0.63, 0.54, and 0.40, respectively). β-blocker exposure also correlated with a significantly lower rate of nonfatal Q-wave infarction or cardiac arrest (relative risk, 0.67). These correlations were only seen for patients undergoing nonvascular surgery.
"In conclusion, our results suggest that early perioperative β-blocker exposure is associated with significantly lower rates of 30-day mortality and cardiac morbidity in patients at elevated baseline cardiac risk undergoing nonvascular surgery," the authors write.
One author disclosed financial ties to the pharmaceutical industry.
Abstract (http://jama.jamanetwork.com/article.aspx?articleid=1681412#Abstract )Full Text (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1681412 )
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