Lack of physician concordance with guidelines on the perioperative use of β-blockers

Preoperative β-blocker use: impact of national guidelines on clinical practice

“…In contrast, 80% of post-guideline patients scheduled for CABG were taking β-blockers, suggesting that preoperative administration of β-blockers is relatively less common than use of β-blockers for other causes, such as cardioprotection after myocardial infarction or for documented significant CAD. These findings are consistent with other studies reporting underprescribing of β-blockers in at-risk surgical [10][11][12][13][14][15][16] and eligible, nonsurgical patients [17][18][19].…”

Needs analysis for the development of a preoperative clinic protocol for perioperative beta-blocker therapy

“…A summary of the existing literature supports the concept that, although perioperative beta-blocker therapy is favored in at-risk patients by most physicians, including anesthesiologists, surgeons, and cardiologists, their use is largely informal and rarely based on established clinical pathways [8,9]. Interestingly, when compared with other physicians, cardiologists were not more likely to start beta-blocker therapy during the preoperative period [9].…”

“…Looking at previous rates of perioperative beta-blocker use in other studies, we noted that Siddiqui et al (2004) [9] had 43% of patients who were candidates, of whom 36% were taking beta blockers, for a total of 15% taking beta blockers. Schmidt et al (2002) [10] reported corresponding rates of 19% and 7%.…”

“…Interestingly, when compared with other physicians, cardiologists were not more likely to start beta-blocker therapy during the preoperative period [9]. More intriguing are data that suggest that despite a cost associated with establishing beta-blocker guidelines, use of beta blockers in at-risk patients could result in decreased cardiovascular morbidity and mortality, with an overall cost saving for the institution [10].…”

Assessing and Reducing the Cardiac Risk of Noncardiac Surgery

“…77 If future trials confirm a protective benefit, the opportunity to reduce mortality may be large. 78 …”