April 24, 2013
Taking a common heart drug before surgery may reduce death rates for some patients, a new study suggests. Researchers looked at non-heart surgeries involving almost 137,000 people. About 40% of the patients took a type of drug called a beta-blocker before surgery and for 30 days afterward. People with a high risk of heart or blood vessel problems were more likely to take these drugs. They slow the heart rate and are used to reduce blood pressure and treat heart rhythm problems. People who took beta-blockers were less likely to die in the 30 days after surgery than similar patients who did not take them. The drugs reduced the risk of death and problems such as heart attack most for higher-risk surgery patients. People with higher risk included those with prior heart disease, stroke, heart failure, diabetes and kidney disease. The Journal of the American Medical Association published the study. HealthDay News wrote about it April 23.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Protecting the heart has always been a big concern for anyone having major surgery. But better techniques for surgery and anesthesia have improved results. The risk of a heart attack and heart-related death has greatly decreased during the last few decades.
Taking a beta-blocker before and after major surgery may be another way to help protect the heart. Examples of commonly prescribed beta-blockers include atenolol, metoprolol and carvedilol.
Early studies suggested that anyone at risk of heart trouble could benefit from taking a beta-blocker before and after major surgery. These drugs slow the heart rate and decrease the heart's work load. But results of later studies were less clear for people having non-vascular surgery. Usually doctors advise a beta-blocker for patients having vascular surgery. (Vascular surgery is surgery on blood vessels. Examples include as fixing an abdominal aortic aneurysm or a bypassing blockage in a leg artery).
Now doctors have a little more guidance from the results of a study published today. The study focused on six factors to find out who is most likely to benefit from taking a beta-blocker before major surgery and at least 30 days afterward. The factors were:
For people with two or more of these risk factors, taking a beta-blocker before surgery and during the next month improved outcomes. They had a significant decrease in their risk of heart attack, cardiac arrest (heart stopping) and death during that time period.
The results of the study were published in the April 24 issue of the Journal of the American Medical Association.
What Changes Can I Make Now?
Are you scheduled for surgery? If you have even one of the risk factors mentioned in the study, ask your doctor whether you should start a beta-blocker.
Anyone over age 50 with multiple heart-disease risk factors might also benefit from treatment with a beta-blocker before surgery. It depends on how many risk factors you have and the type of surgery.
As a reminder, those heart-disease risk factors include:
Ideally, people who are not already taking a beta-blocker but need one should start taking it at least one week before surgery. I prefer to start it two or more weeks before surgery when possible. I start at a low dose and increase the dose gradually. Beta-blockers slow the heart rate. So this can guide the dosing. The heart-rate goal depends on the individual patient.
What Can I Expect Looking to the Future?
During the last few years, doctors have become less likely to prescribe beta-blockers before surgery for people not already taking them. The evidence was not conclusive. But this new study helps define which patients are likely to get the most benefit. Beta-blocker therapy for this purpose will almost surely increase.
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