ACC / AHA revised guidelines for the use of perioperative beta-blockers reduce cardiac risk among

Cardiac complications during the period of cardiac surgery are relatively common and can have serious consequences. The American College of Cardiology (ACC) and the American Heart Association (AHA) today released an update on practice guidelines recalibrated based on new data from clinical studies, and provides a summary information on risks and benefits of the use of beta - blockers to reduce cardiac events during noncardiac surgery, and provides specific recommendations for patients will benefit and which patients do not enough evidence to recommend their use. "Each operation, in particular, a high-risk procedure, pressure on the heart, especially for those with other cardiovascular problems or other cardiovascular risk factors," said Kirsten E. Fleischmann, MD, MPH, chairman of the drafting group of the 2009 review the latest findings on the use of perioperative beta-blockers. "In general, the risk, the higher the probability of a perspective cardiovascular patients benefit from beta-blockers. But recent data from the [POISE Perioperative Ischemic Evaluation] study suggest that at higher doses of beta-blockers strongly on the day of surgery is associated with risks and so careful selection of patients, dose adjustment and monitoring during the perioperative period is the key. "

More than 30 million heart surgeries are performed in the United States each year. Heart problems in the time of surgery are a major cause of complications and death in these patients prolong hospital stays and increasing costs. Beta-blockers are blocking to protect against heart attack, at the time of surgery by a decrease in heart rate and contribute to the effects of stress hormones on the heart.

The recommendation that beta-blockers perioperatively in patients who have already received, there is ongoing since the first guidelines published in 2007. The working group advises the beta-blockers are useful to consider:

* Patients at high risk of heart attack or other cardiac complications due to abnormal stress tests or known coronary artery disease undergoing vascular surgery
* Patients at high risk for surgery or moderate risk in patients with multiple risk factors for complications (eg diabetes, history of heart failure, significant renal disease) undergoing vascular surgery

The authors warn, however, that are started when the beta-blockers in patients not taking them, should take well before the cases are opened, allowing them gradually as blood pressure and heart rate.

"We recommend beta-blockers may also be initiated before surgery and not at doses higher today," said Dr. Fleischmann. "These guidelines are updated to serve as guidelines for appropriate use of beta blockers help reduce the risk of cardiac complications. Physicians must be vigilant in assessing the risks of heart patients and weighing this against the possible side effects of treatment. "

According to the authors, is the benefit of beta-blockers in patients with a lower risk in these uncertain, or subjected to any risk operations (eg, percutaneous or endovascular procedure) and requires an assessment careful risk and benefit.

The guidelines do not recommend routine administration of beta-blockers, especially in fixed doses higher on the day of the operation on the data of the study, which began Poise. Although there was a decrease in perioperative myocardial infarction and primary cardiac events among study participants was the use of beta-blockers with higher rates of stroke and mortality overall. Beta-blockers should not be used if there are cons-indications.