Questions Continue About Using Beta Blockers Before Surgery

Study finds increased risk of death, heart attacks

By Ed Edelson
HealthDay Reporter

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MONDAY, Oct. 20 (HealthDay News) -- A new study adds to doubts about using beta blockers to reduce the risks of surgery.

The death rate for people given beta blockers before non-cardiac surgery was 10 times higher in the 30 days after an operation than for those not getting the drugs (2.52 percent vs. 0.25 percent), according to a report in the October issue of the Archives of Surgery. The incidence of heart attacks was four times higher (2.94 percent vs. 0.74 percent).

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"This is very much in line with the latest publications showing that one has to be very careful in using them," said study co-author Dr. Kamal Itani, chief of surgery at the Veterans Affairs Boston Health Care System and a professor of surgery at Boston University.

Beta blockers are commonly given before surgery to reduce cardiac risk by slowing the heartbeat. The Boston study found that the risk of problems was concentrated in those whose heart rates remained high despite beta-blocker treatment.

The new results differ somewhat from those of a major international study reported earlier this year. The POISE study of 8,351 people having non-cardiac surgery found a 27 percent reduction in heart attacks but an overall 33 percent higher death rate for those getting beta blockers.

Despite those results, beta blockers do have a role in surgery, Itani said. "I think we have to be careful about which patients receive beta blockers," he said. "There are clearly benefits for those drugs in patients at the highest risk of complications and with risk factors for heart disease."

The important point is to be sure that the target heartbeat rate is achieved, Itani said. The American College of Cardiology recommends 50 beats to 60 beats per minute before surgery, not to exceed 80 beats per minute, he noted.

"Those patients who do not have the target rate going into surgery will not do as well," Itani said. "Giving the drugs without achieving the full potential might be dangerous."

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