The potential preventability of postoperative myocardial infarction: underuse of perioperative β-adrenergic blockade

Lindenauer, Peter K.; Fitzgerald, J; Hoople, Nancy E.; Benjamin, Evan M.

doi:10.1016/j.accreview.2004.06.022

Cited by 18 publications

(21 citation statements)

References 19 publications

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“…Of 58 patients who were found retrospectively to have been "ideal" candidates for perioperative ␤-blockade, only 30 (52%) actually received this treatment-a figure quite similar to the findings in the current study (Addition ϩ Continuation groups ϭ 48%). 11 This finding suggests that undertreatment is still common, and prospective identification and treatment could potentially decrease perioperative mortality further still. Lindenauer et al 11 found that treatment with ␤-blockers before infarction was associated with reduced mortality (OR, 0.19; 95% CI, 0.04 -0.87).…”

Section: Discussionmentioning

confidence: 97%

“…Lindenauer et al 11 analyzed the pattern of use of perioperative ␤-blockade by review of medical records of patients who developed postoperative myocardial infarctions in a single hospital. Of 58 patients who were found retrospectively to have been "ideal" candidates for perioperative ␤-blockade, only 30 (52%) actually received this treatment-a figure quite similar to the findings in the current study (Addition ϩ Continuation groups ϭ 48%).…”

Section: Discussionmentioning

confidence: 99%

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Association of the Pattern of Use of Perioperative β-Blockade and Postoperative Mortality

2010

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Background:The 1996 atenolol study provided evidence that perioperative ␤-adrenergic receptor blockade (␤-blockade) reduced postsurgical mortality. In 1998, the indications for perioperative ␤-blockade were codified as the Perioperative Cardiac Risk Reduction protocol and implemented at the San Francisco Veterans Administration Medical Center, San Francisco, California. The present study analyzed the association of the pattern of use of perioperative ␤-blockade with perioperative mortality since introduction of the Perioperative Cardiac Risk Reduction protocol. Methods: Epidemiologic analysis of the operations undertaken since 1996 at the San Francisco Veterans Administration Medical Center was performed. The pattern of use of perioperative ␤-blockade was divided into four groups: None, Addition, Withdrawal, and Continuous. Logistic regression, survival analysis, and propensity analysis were performed. Results: A total of 38,779 operations were performed between 1996 and 2008. In patients meeting Perioperative Cardiac Risk Reduction indications for perioperative ␤-blockade, Addition is associated with a reduction in 30-day (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.33 to 0.83; P ϭ 0.006) and 1-yr mortality (OR, 0.64; 95%, CI 0.51 to 0.79; P Ͻ 0.0001). Continuous is associated with a reduction in 30-day (OR, 0.68; 95% CI, 0.47 to 0.98; P ϭ 0.04) and 1-yr mortality (OR, 0.82; 95% CI, 0.67 to 1.0; P ϭ 0.05). Withdrawal is associated with an increase in 30-day (OR 3.93, 95% CI, 2.57 to 6.01; P less than 0.0001) and 1-yr mortality (OR, 1.96; 95% CI, 1.49 to 2.58; P Ͻ 0.0001). Conclusion: Perioperative ␤-blockade administered according to the Perioperative Cardiac Risk Reduction protocol is associated with a reduction in 30-day and 1-yr mortality. Perioperative withdrawal of ␤-blockers is associated with increased mortality.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Association of the Pattern of Use of Perioperative β-Blockade and Postoperative Mortality

2010

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“…2 Although they occur infrequently, postoperative cardiovascular complications are associated with a substantial risk of other complications and death, 3,4 and preventing such complications is often the rationale for preoperative medical consultation.…”

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confidence: 99%

Perioperative Beta-Blocker Therapy and Mortality after Major Noncardiac Surgery

Lindenauer

Pekow

Wang³

et al. 2005

N Engl J Med

790

412

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

Section: Discussionmentioning

confidence: 99%

Assessing and Reducing the Cardiac Risk of Noncardiac Surgery

2006

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A ccurate estimation of a patient's risk for postoperative cardiac events (eg, myocardial infarction, unstable angina, ventricular tachycardia, pulmonary edema, and death) after noncardiac surgery can guide allocation of clinical resources, use of preventive therapies, and priorities for future research. This review addresses selected issues in clinical risk assessment, approaches to using diagnostic tests, choices among preventive interventions, and postoperative monitoring. Although we have not used a formal systematic

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The potential preventability of postoperative myocardial infarction: underuse of perioperative β-adrenergic blockade

Cited by 18 publications

References 19 publications

Association of the Pattern of Use of Perioperative β-Blockade and Postoperative Mortality

Association of the Pattern of Use of Perioperative β-Blockade and Postoperative Mortality

Perioperative Beta-Blocker Therapy and Mortality after Major Noncardiac Surgery

Assessing and Reducing the Cardiac Risk of Noncardiac Surgery

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