title: Preoperative beta-blocker use: is titration to a heart rate of 60 beats per minute a consistently attainable goal?
abstract: 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.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520-8051, USA. shamsuddin.akhtar@yale.edu
authors.forename: Shamsuddin
authors.initials: S
authors.lastname: Akhtar
authors.forename: Muzna
authors.initials: M
authors.lastname: Amin
authors.forename: Hossam
authors.initials: H
authors.lastname: Tantawy
authors.forename: Audrey
authors.initials: A
authors.lastname: Senior
authors.forename: Paul G
authors.initials: PG
authors.lastname: Barash
authors.forename: David G
authors.initials: DG
authors.lastname: Silverman
mesh_terms: 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
chemical_list: D000319:Adrenergic beta-Antagonists