During a preoperative evaluation of a 66 year old male for elective non-cardiac surgery you find that he had an MI ten years ago. Since that time the patient has made lifestyle modifications (healthy diet and increased exercise), has a resting heart rate of 72 and has not had any new cardiac problems. He asks you if he should be taking a beta-blocker before surgery because he has heard that people with a history of heart disease should all be on beta blockers whey they have surgery. Should preoperative beta blockers be prescribed to prevent perioperative cardiovascular complications?
Download the worksheet (with tips!) to guide your practice of:
Open to check your PICOTT analysis of the scenario.
P (Patient, population) = 66 year old male, history of heart disease
I (Intervention) = preoperative beta blockers
C (Comparison) = none
O (Outcome) = prevent perioperative cardiac complications
T (Type of Question) = therapy
T (Type of Study) = therapy hierarchy starting with systematic review of randomized trials
Open to check your PubMed search.
Search as entered in PubMed: (preoperative OR perioperative) AND beta blockers AND (prevent OR preventing OR prevention) AND (heart OR cardiac OR cardiovascular) AND (complications OR mortality OR morbidity)
PubMed Search Details: (preoperative[All Fields] OR perioperative[All Fields]) AND ("adrenergic beta-antagonists"[Pharmacological Action] OR "adrenergic beta-antagonists"[MeSH Terms] OR ("adrenergic"[All Fields] AND "beta-antagonists"[All Fields]) OR "adrenergic beta-antagonists"[All Fields] OR ("beta"[All Fields] AND "blockers"[All Fields]) OR "beta blockers"[All Fields]) AND (("Prevent"[Journal] OR "prevent"[All Fields]) OR preventing[All Fields] OR ("prevention and control"[Subheading] OR ("prevention"[All Fields] AND "control"[All Fields]) OR "prevention and control"[All Fields] OR "prevention"[All Fields])) AND (("heart"[MeSH Terms] OR "heart"[All Fields]) OR ("heart"[MeSH Terms] OR "heart"[All Fields] OR "cardiac"[All Fields]) OR ("cardiovascular system"[MeSH Terms] OR ("cardiovascular"[All Fields] AND "system"[All Fields]) OR "cardiovascular system"[All Fields] OR "cardiovascular"[All Fields])) AND (("complications"[Subheading] OR "complications"[All Fields]) OR ("mortality"[Subheading] OR "mortality"[All Fields] OR "mortality"[MeSH Terms]) OR ("epidemiology"[Subheading] OR "epidemiology"[All Fields] OR "morbidity"[All Fields] OR "morbidity"[MeSH Terms]))
Type of Article: Use either the Article Type filter or a Clinical Query search to see if there are Meta-Analysis or Systematic Reviews.
Open to see the article references selected from a search on November 13, 2014.
1: Blessberger H, Kammler J, Domanovits H, Schlager O, Wildner B, Azar D, Schillinger M, Wiesbauer F, Steinwender C. Perioperative beta-blockers for preventing surgery-related mortality and morbidity. Cochrane Database Syst Rev. 2014 Sep 18;9:CD004476. doi: 10.1002/14651858.CD004476.pub2. PubMed PMID: 25233038.
2: Bouri S, Shun-Shin MJ, Cole GD, Mayet J, Francis DP. Meta-analysis of secure randomised controlled trials of β-blockade to prevent perioperative death in non-cardiac surgery. Heart. 2014 Mar;100(6):456-64. doi: 10.1136/heartjnl-2013-304262. Epub 2013 Jul 31. Review. PubMed PMID: 23904357; PubMed Central PMCID: PMC3932762.
3: Guay J, Ochroch EA. β-blocking agents for surgery: influence on mortality and major outcomes. A meta-analysis. J Cardiothorac Vasc Anesth. 2013 Oct;27(5):834-44. doi: 10.1053/j.jvca.2013.01.009. Epub 2013 Jun 19. PubMed PMID: 23790500.
Be sure to also read the commentaries linked below the abstracts fo these articles.