New ACC/AHA Guidelines: Focused Update on Perioperative Beta Blockers

On Monday, the American College of Cardiology and American Heart Association released the 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade, an addendum to the ACC/AHA 2007 Guidelines on Perioperative CardiovascularEvaluation and Care for Noncardiac Surgery. This focused update was added due to new clinical trial data that “summarizes and sheds light on the risks and benefits of using beta blockers to reduce cardiac events during noncardiac surgeries.”

Every year, more than 30 million noncardiac surgeries are performed in the US. Patients who have cardiac problems prior to their surgery are at a higher risk of experiencing complications or death, longer hospital visits, and an increase in costs. Treating patients with beta blockers before surgery may reduce these risks.

Based on their research, the workgroup advises the use of beta blockers for the following patients:

• Patients at high risk for heart attacks or other cardiac complications because of abnormal stress test results or known coronary artery disease who undergo vascular surgery
• High risk patients undergoing intermediate risk surgery or in those with multiple risk factors for complications who undergo vascular surgery.

Kirsten E. Fleischmann, MD, MPH, chair of the 2009 writing group that reviewed the data, said, “In general, the higher the risk from a cardiovascular standpoint, the more likely a patient will benefit from beta blockers. However, newer data from the POISE [Perioperative Ischemic Evaluation] trial suggest that starting higher doses of beta blockers acutely on the day of surgery is associated with risk as well.”

Although beta blockers are beneficial to patients undergoing noncardiac surgery, it is important that cardiologists monitor their patients carefully.