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Preoperative beta-blocker use: impact of national guidelines on clinical practice
Shamsuddin Akhtar1, Sheriff Assaad, Muzna Amin
1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520-8051, USA. shamsuddin.akhtar@yale.edu
Insights
Publication of perioperative beta-blocker guidelines did not significantly increase their use or improve heart rate control in eligible surgical patients. Preoperative beta-blocker therapy rates and target heart rate achievement remained largely unchanged post-guideline implementation.
Area of Science:
- Cardiology
- Anesthesiology
- Pharmacology
Background:
- Clinical practice guidelines recommend perioperative beta-blocker therapy for specific patient groups.
- Adherence to these recommendations is crucial for optimizing patient outcomes.
- Assessing the impact of guideline publication on clinical practice is essential.
Purpose of the Study:
- To evaluate the effect of published recommendations on perioperative beta-blocker therapy.
- To determine if eligible presurgical patients were more likely to receive beta-blockers post-guideline.
- To assess if target heart rate (HR <60 bpm) achievement improved after guideline dissemination.
Main Methods:
- Retrospective observational study design.
- Analysis of 718 patients undergoing elective vascular surgery or coronary artery bypass grafting.
- Comparison of beta-blocker usage and heart rate control pre- and post-guideline publication.
Main Results:
- No significant increase in preoperative beta-blocker use was observed in vascular surgery or coronary artery bypass grafting patients.
- Mean heart rate in vascular surgery patients on beta-blockers was higher post-guideline (70 bpm) compared to pre-guideline (65 bpm).
- Target heart rate achievement (<60 bpm) did not significantly improve in either surgical group post-guideline.
Conclusions:
- Guideline publication did not significantly alter preoperative beta-blocker utilization at this institution.
- The study suggests limited impact of the recommendations on current clinical practice regarding beta-blocker therapy.
- Further strategies may be needed to improve adherence to perioperative beta-blocker guidelines.
Study 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]).
Design:
Retrospective, observational study.
Setting:
Tertiary-care teaching hospital.
Measurements:
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.
Main 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).
Conclusion:
At our institution, preoperative beta-blocker use was not significantly changed by publication of the recommendations.
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