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JAMA Clinical Evidence Synopsis |

Perioperative Use of β-Blockers in Cardiac and Noncardiac Surgery

Hermann Blessberger, MD1; Juergen Kammler, MD1; Clemens Steinwender, MD1
[+] Author Affiliations
1Department of Internal Medicine 1—Cardiology, Linz General Hospital, Johannes Kepler University Linz School of Medicine, Austria
JAMA. 2015;313(20):2070-2071. doi:10.1001/jama.2015.1883.
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Clinical Question  Are β-blockers associated with lower rates of mortality and morbidity after cardiac or noncardiac surgery?

Bottom Line  In cardiac surgery, β-blockers are associated with a lower incidence of supraventricular tachycardias (SVTs) and ventricular arrhythmias. In noncardiac surgery, β-blockers are associated with a possible increase in mortality and strokes, a lower incidence of acute myocardial infarctions (AMIs) and SVTs, and an increase in bradycardia and hypotension. If tolerated, long-term β-blocker treatment should be continued perioperatively, whereas the decision to start a β-blocker should be individualized, weighing risks and benefits.

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Figure.
Association of β-Blocker Treatment and Type of Control Group With All-Cause Mortality in Noncardiac Surgery

Source: Data have been adapted with permission from Wiley.1 Size of the square markers indicate number of randomized patients for each trial. The 3 diamond markers with their respective lateral dimensions depict summary estimates and corresponding 95% CIs. Although no evidence of an association was found when all trials were combined, a statistically significant increase in all-cause mortality with the use of β-blockers was detected, if only placebo-controlled trials were analyzed.1

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