Association of Beta-Blocker Therapy With Risks of Adverse Cardiovascular Events and Deaths in Patients With Ischemic Heart Disease Undergoing Noncardiac Surgery: A Danish Nationwide Cohort Study

Mar 03, 2014
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Authors:
Andersson C, Mérie C, Jørgensen M, et al.
Citation:
JAMA Intern Med 2014;174:336-344.
Summary By:
Prashant Vaishnava, MD, FACC

Study Questions:

What are associations of beta-blocker treatment with major adverse cardiovascular events (MACE) and all-cause mortality in patients with ischemic heart disease undergoing noncardiac surgery?

Methods:

This was a retrospective analysis of individuals with ischemic heart disease with or without heart failure (HF) and with or without a history of myocardial infarction (MI) undergoing noncardiac surgery between 2004 and 2009. Patients were identified from nationwide Danish registries. Treatment with beta-blockers was defined as at least one claimed prescription of beta-blockers within 4 months before surgery. The primary and secondary endpoints were 30-day risk of MACE and all-cause mortality within 30 days of surgery, respectively.

Results:

In adjusted analyses, the use of beta-blockers was associated with a hazard ratio (HR) of 0.90 (95% confidence interval [CI], 0.79-1.02) for MACE and 0.95 (95% CI, 0.85-1.06) for all-cause mortality. The adjusted HR associated with beta-blocker treatment for MACE was significantly lower among patients with HF (0.78; 95% CI, 0.66-0.91) than among patients without HF (1.11; 0.92-1.33). Patients with a recent MI (defined as within 2 years) had a lower HR for MACE associated with beta-blocker treatment (0.54; 95% CI, 0.37-0.78), but not for all-cause mortality (0.80; 95% CI, 0.53-1.21).

Conclusions:

In individuals with ischemic heart disease, perioperative beta-blocker (defined as at least one claimed prescription of beta-blocker within 4 months before surgery) was associated with decreased MACE and all-cause mortality only among those with HF or recent MI within 2 years.

Perspective:

There are mixed opinions about the use of beta-blockade perioperatively. The current analysis corroborates current practice to continue pre-existing beta-blocker therapy. The authors demonstrate improved outcomes with beta-blocker therapy in patients with HF or recent MI (patients likely to be on beta-blocker anyway). Such patients should continue beta-blockade perioperatively without discontinuation. Future studies and randomized clinical trials should better define other patient subgroups who would (or would not) benefit from perioperative beta-blockade.

Keywords: Registries, Myocardial Infarction, Heart Failure


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