Perioperative beta-blockers therapy for non-cardiac surgery: A focused update of ACC/AHA Guidelines

The American College of Cardiology and The Americal Heart Association has released an update of the guidelines on perioperative cardiovascular evaluation for non-cardiac surgery. Lates update focuses on perioperative beta-blocker therapy. The guidelines were published in the Journal of American College of Cardiology.

The purpose of this guideline update was to address the issue of perioperative beta-blockade for non-cardiac surgery which has taken on increased importance since the guidelines for perioperative cardiovascular evaluation for non-cardiac surgery was released in 2002. The National Quality Forum and the Surgical Care Improvement Project have both identified perioperative beta-blockade as a quality measure. The guideline update was published given the importance of these quality measures for both public reporting and eventual pay-for-performance, and the recent series of publications on the subject.

Following are the recommendations for Beta-Blocker Medical Therapy

• 1 Beta-blockers should be continued in patients undergoing surgery who are receiving beta-blockers to treat angina, symptomatic arrhythmias, hypertension, or other ACC/AHA guideline indications.


• 2 Beta-blockers should be given to patients undergoing vascular surgery at high cardiac risk owing to the finding of ischemia on preoperative testing.

Class IIa (weight of evidence/opinion is in favor of usefulness/efficacy)

• 1 Beta-blockers are probably recommended for patients undergoing vascular surgery in whom preoperative assessment identifies coronary heart disease.


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  Beta-blockers are probably recommended for patients in whom preoperative assessment for vascular surgery identifies high cardiac risk as defined by the presence of multiple clinical risk factors.*

  
  


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  Beta-blockers are probably recommended for patients in whom preoperative assessment identifies coronary heart disease or high cardiac risk as defined by the presence of multiple clinical risk factors* and who are undergoing intermediate- or high-risk procedures as defined in these guidelines.

  
  

Class IIb (usefulness/efficacy is less well established by evidence/opinion)

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  Beta-blockers may be considered for patients who are undergoing intermediate- or high-risk procedures as defined in these guidelines, including vascular surgery, in whom preoperative assessment identifies intermediate cardiac risk as defined by the presence of a single clinical risk factor.*

  
  


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  Beta-blockers may be considered in patients undergoing vascular surgery with low cardiac risk (as defined in these guidelines) who are not currently on beta-blockers.

  
  

Class III (conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful/effective, and in some cases may be harmful)

• 1 Beta-blockers should not be given to patients undergoing surgery who have absolute contraindications to beta-blockade.

For further reference, click on the link

https://doi.org/10.1161/CIRCULATIONAHA.109.192690