title: Preoperative beta-blocker use: impact of national guidelines on clinical practice.
abstract: OBJECTIVE
  To determine if recommendations regarding perioperative beta-blocker therapy were followed by an increase in the number of eligible presurgical patients receiving beta-blockers and the number achieving the recommended heart rate (HR <60 beats per minute [bpm]).
  
  
  METHODS
  Retrospective, observational study.
  
  
  METHODS
  Tertiary-care teaching hospital.
  
  
  METHODS
  The records of all 718 patients who underwent elective vascular surgery or coronary artery bypass grafting between January 2001 and March 2002 (pre-guideline) and those who did so between April 2002 and September 2003 (post-guideline) were reviewed. Percentage of eligible patients who received beta-blockers preoperatively and the target HR achieved in pre-guideline versus post-guideline patients were recorded. Differences were assessed using the unpaired t test and chi2 analysis. A P value of less than 0.05 is reported.
  
  
  RESULTS
  Fifty percent of the post-guideline patients in the vascular surgery group were receiving beta-blockers at the time of preanesthetic evaluation versus 48% of pre-guideline patients (P = nonsignificant [NS]). Mean HR in the vascular surgery post-guideline beta-blocker group (70 +/- 14 bpm) was higher than in the pre-guideline beta-blocker group (65 +/- 11 bpm) (P < 0.01). Only 22% of those vascular surgery patients in the post-guideline group who were taking beta-blockers achieved the target HR of less than 60 bpm versus 29% of the vascular surgery patients taking beta-blockers in the pre-guideline group (P = NS). In the coronary artery bypass grafting group, 80% of post-guideline patients received beta-blocker before anesthesia assessment versus 75% of pre-guideline patients (P = NS). Mean HR in the post-guideline beta-blocker group (67 +/- 15 bpm) was similar to the pre-guideline beta-blocker group (64 +/- 13 bpm) (P = NS). Only 28% of the post-guideline patients who were receiving beta-blockers achieved the target HR of less than 60 bpm, which was not significantly different from the 17% achieved in the pre-guideline group (P = NS).
  
  
  CONCLUSIONS
  At our institution, preoperative beta-blocker use was not significantly changed by publication of the recommendations.
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: Sheriff
authors.initials: S
authors.lastname: Assaad
authors.forename: Muzna
authors.initials: M
authors.lastname: Amin
authors.forename: Natalie F
authors.initials: NF
authors.lastname: Holt
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 / Q000627:therapeutic use*; D000368:Aged; D005260:Female; D019983:Guideline Adherence; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
chemical_list: D000319:Adrenergic beta-Antagonists