Preoperative beta-blocker use: is titration to a heart rate of 60 beats per minute a consistently attainable goal?
OBJECTIVE
To quantify the prevalence of perioperative beta-blocker use and its impact on preoperative and preinduction heart rate (HR), in light of the recent publication of specific recommendations regarding perioperative beta-blocker use and desired HR.


METHODS
Retrospective observational study in patients who underwent elective and coronary artery bypass graft (CABG) surgery between January 2001 and March 2002.


METHODS
Tertiary-care teaching hospital.


METHODS
Percentage of eligible patients who received beta-blockers preoperatively and the impact of non-protocol-based beta-blocker therapy on preadmission and preinduction HR were recorded. Differences were assessed with unpaired t test and chi(2) analysis; P < .05 was considered significant, with corrections for multiple comparisons.


RESULTS
Of the patients who underwent vascular surgery, 9 had documented prior beta-blocker intolerance. Of the remaining 172 patients, 94.8% had indication for perioperative beta-blocker use. However, only 47.7% of the eligible patients received beta-blockers. Of the 155 CABG patients, 74.2% were taking beta-blockers preoperatively. Only 29% of vascular patients and 32% of CABG patients who were receiving beta-blockers had HR less than 60 beats per minute (bpm) at preadmission. The mean preadmission HR in vascular surgery patients was 65.2 +/- 11 and 73.2 +/- 13.8 bpm in beta-blocker and non-beta-blocker patients, respectively (P = .0001). In CABG surgery patients, preadmission HR values were 64.2 +/- 13 and 76.1 +/- 12 bpm in beta-blocker and non-beta-blocker patients, respectively (P = .001). The preinduction HR subsequently increased in the beta-blocker as well as in the non-beta-blocker groups.


CONCLUSIONS
Only half of the patients who qualify to receive preoperative beta-blockers by current recommendations actually receive them before noncardiac surgery, and the majority of these patients have preadmission and preinduction HR less than 60 bpm. Targeting beta-blocker therapy treatment to an HR less than 60 bpm may not be readily achievable in many patients.
Akhtar
Shamsuddin
S
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520-8051, USA. shamsuddin.akhtar@yale.edu
Amin
Muzna
M
Tantawy
Hossam
H
Senior
Audrey
A
Barash
Paul G
PG
Silverman
David G
DG
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000368:Aged; D001026:Coronary Artery Bypass; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures
D000319:Adrenergic beta-Antagonists