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

Akhtar, Shamsuddin; Assaad, Sheriff; Amin, Muzna; Holt, Natalie; Barash, Paul G.; Silverman, David G.

doi:10.1016/j.jclinane.2007.09.012

Cited by 8 publications

(3 citation statements)

References 38 publications

(44 reference statements)

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“…Studies of adherence to perioperative beta-blocker guidelines have so far focused primarily on institutional behavior by studying hospital or care-giver adherence to perioperative beta-blocker recommendations. 15-17 Our study highlights that even institutions or individual physicians who strictly follow beta-blocker recommendations likely still have a great deal of work to do to maximize cardiac protection among patients.…”

Section: Discussionmentioning

confidence: 94%

Beta-Blocker Withdrawal Among Patients Presenting for Surgery from Home

Schonberger

Lukens

Türkoğlu

et al. 2012

Journal of Cardiothoracic and Vascular Anesthesia

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Structured Abstract Objective This study sought to measure the incidence of perioperative beta-blocker non-compliance by patients who were prescribed chronic beta blocker therapy and presented for surgery from home. The effect of patient non-compliance on day of surgery presenting heart rate was also examined. Design Prospective observational study with outcome data obtained from review of the medical record. Setting The preoperative clinic and operating rooms of a Veterans Administration hospital. Participants Patients on chronic beta blocker therapy who presented from home for surgery. Interventions None. Measurements and Main Results Demographic and comorbidity data as well as data on self-reported compliance to beta-blocker therapy, initial day of surgery vital signs, and recent ambulatory vital signs were collected. Ten out of fifty subjects (20%; 95% CI = 9-31%) reported not taking their day of surgery beta-blocker. These self-reported non-adherers demonstrated a higher presenting heart rate on the day of surgery vs. adherent subjects (median of 78 beats per minute vs. 65 beats per minute, p=0.02 by Wilcoxon Rank-Sum Test). The difference-in-difference between baseline primary care and day of surgery heart rate was also statistically significant between compliant and non-compliant subjects (-7 beats per minute vs. +12.5 beats per minute, p<0.00001). Conclusions Patient self-report and physiologic data documented failure to take beta-blockers and possible beta-blocker withdrawal in 20% of patients who presented for surgery from home. If these findings are confirmed in larger studies, improved patient understanding of and compliance with medication instructions during preoperative visits should be a focus of future quality improvement initiatives.

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Section: Discussionmentioning

confidence: 94%

Beta-Blocker Withdrawal Among Patients Presenting for Surgery from Home

Schonberger

Lukens

Türkoğlu

et al. 2012

Journal of Cardiothoracic and Vascular Anesthesia

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“…3 Depending on the planned procedure, the patients with intermediate risk may be suffi ciently β-blocked or may be considered for further diagnostic analyses. [3][4][5] …”

Section: Introductionmentioning

confidence: 99%

Preoperative evaluation and a risk assessment in patients undergoing abdominal surgery

et al. 2010

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Patients who undergo abdominal surgery present along a variable spectrum of health. This ranges from the healthy young patient undergoing elective hemorrhoid surgery to the octogenarian in unstable health with multiple comorbidities. Regardless of a patient's current state of health, a preoperative assessment is crucial in planning the operative approach and in recognizing the possible postoperative complications for the implementation of a proper intervention if necessary. A broad evaluation of the patient includes identifying conditions that may predispose the patient to risks and the complications not directly related to the surgical procedure. The purpose of this article is to review the preoperative assessment in patients undergoing simple to complex procedures. The article provides general guidelines for the preoperative workup, which should be individualized for each patient, and the planned procedure, with the goal of reducing the postoperative complications. Risk stratification depends on a patient's condition and the extension of the planned surgical approach. It may also help to improve the postoperative outcome. A further preoperative workup should be individualized and tailored to the complexity of each case.

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“…In that study, only 20% of vascular surgery patients underwent noninvasive cardiac testing when recommended by the 2002 perioperative guidelines. Similarly, Akhtar et al showed that preoperative beta-blocker use in patients with peripheral vascular disease or CAD did not change at Yale-New Haven Hospital following the 2002 ACC/AHA guidelines [17], which recommended perioperative beta-blocker use in highrisk patients [3]. Interestingly, only 50% of patients undergoing vascular surgery were taking beta blockers preoperatively.…”

mentioning

confidence: 99%

Follow your heart? Adherence to guidelines during preoperative cardiac evaluation

Hepner

2010

Journal of Clinical Anesthesia

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

Cited by 8 publications

References 38 publications

Beta-Blocker Withdrawal Among Patients Presenting for Surgery from Home

Beta-Blocker Withdrawal Among Patients Presenting for Surgery from Home

Preoperative evaluation and a risk assessment in patients undergoing abdominal surgery

Follow your heart? Adherence to guidelines during preoperative cardiac evaluation

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