November 13, 2013
Beta Blockers May Increase Risk of Cardiac Events in
Surgical Patients

Chicago—Beta-blockers may actually increase the risk of an adverse cardiac event in patients undergoing a noncardiac surgical procedure, according to a recent research presentation.

The poster, presented recently at CHEST 2013, the annual meeting of the American College of Chest Physicians, also suggests a greater risk of irregular heartbeat and worsening of symptoms in patients with existing heart disease.

Researchers at the State University of New York (SUNY)-Upstate Medical University Hospital analyzed 755 patients who had undergone noncardiac surgery in a single university-based center, with patients randomly chosen and classified according to gender, ethnicity, risk of surgery, and whether beta-blockers were used before, during, or after a noncardiac surgical procedure.

The study looked at six different outcomes—all-cause mortality, ACS, significant arrhythmias, cardiac event–related death, bradycardia, and decompensated heart failure. Beta-blocker administration, revised cardiac risk index score, and risk of surgery were used to predict these outcomes.

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

Beta-blocker use was found to increase the odds of having an acute coronary event by a factor of 21.76. Decompensated heart failure was also seen to increase by an odds ratio of 4.50.

Researchers expressed surprise that the risk of arrhythmias also showed an increase, with an odds ratio of 2.96, but said that, due to a small event rate, statistical correctional formulas had to be utilized to stabilize results.

“These results become especially important in view of the fact that beta-blockers are currently recommended by the American College of Cardiology/American Heart Association (ACC/AHA) 2011 guidelines regarding perioperative cardiac risk stratification and management,” the researchers write. “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.”

U.S. Pharmacist Social Connect