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.
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.*
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)
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.*
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.
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