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JAMA Clinical Guidelines Synopsis |

Perioperative β-Blocker Therapy

Todd Stern, MD1; Adam S. Cifu, MD1
[+] Author Affiliations
1University of Chicago, Chicago, Illinois
JAMA. 2015;313(24):2486-2487. doi:10.1001/jama.2015.3086.
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Published online

Extract

This JAMA Clinical Guidelines Synopsis article summarizes the evidence for perioperative use of β-blockers in patients with or at risk of developing cardiovascular disease.

Box Section Ref ID

Guideline title Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

Developers American College of Cardiology (ACC)/American Heart Association (AHA)

Release date August 1, 2014 (online)

Prior versions November 2009, October 2007, June 2006

Funding sources ACC/AHA

Target population Patients with or at risk of developing cardiovascular disease who are being evaluated for noncardiac surgery

Major recommendations

  • In patients undergoing surgery who have been taking β-blockers for chronic conditions, β-blockers should be continued (class I; level of evidence B).

  • It is reasonable for the management of β-blockers after surgery to be guided by clinical circumstances independent of when the β-blocker was started (class IIa; level of evidence B).

  • In patients with intermediate- or high-risk myocardial ischemia noted in preoperative risk stratification tests, it may be reasonable to begin perioperative β-blockers (class IIb; level of evidence C).

  • In patients with 3 or more Revised Cardiac Risk Index risk factors, it may be reasonable to begin β-blockers before surgery (class IIb; level of evidence B).

  • In patients with a compelling long-term indication for β-blocker therapy but no other Revised Cardiac Risk Index risk factors, initiating β-blockers in the perioperative setting to reduce perioperative risk is of uncertain benefit (class IIb; level of evidence B).

  • In patients in whom β-blocker therapy is initiated, it may be reasonable to begin perioperative β-blockers long enough in advance to assess safety and tolerability, preferably more than 1 day before surgery (class IIb; level of evidence B).

  • β-Blocker therapy should not be started on the day of surgery (class III [harm]; level of evidence B).

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