Patients
Who Take Beta Blockers before Coronary Bypass Surgery have Improved
Outcomes
Patients who take beta blockers (drugs to slow the heart rate and
reduce contractions of the heart muscle) prior to bypass surgery appear
to have improved survival and fewer complications during and after
the procedure, according to an Agency for Healthcare Research and
Quality (AHRQ) study. Researchers indicate that up to 1,000 lives
potentially could be saved each year by giving patients beta blockers.
The study, the first to examine
the outcomes of beta blocker use before bypass surgery, was conducted
by researchers at the Society of Thoracic Surgeons and the Duke
Clinical Research Institute and is being published in the May 1,
2002, issue of the Journal of the American Medical Association (JAMA).
Patients who took beta blocker
therapy before bypass surgery had lower rates of death in and out
of the hospital within 30 days of surgery than those who did not
have the therapy, 2.8 percent versus 3.4 percent, respectively.
This modest survival benefit remained after adjusting for multiple
preoperative risk factors such as diabetes and age. Also, use of
beta blockers improved outcomes in patients for whom this therapy
is considered risky. These include patients with heart failure,
older age, underlying lung disease, and diabetes. In addition, use
of beta blockers lessened the incidence of major complications,
including stroke, renal failure, and extended duration of ventilation.
While bypass surgery is one
of the most commonly performed procedures in North America, only
about 60 percent of patients were taking a beta blocker at the time
of their surgery, according to researchers. They believe that these
study results should increase the awareness of cardiovascular care
providers to the potential benefits of beta blockers in patients
with both medical and surgical cardiovascular disease. In addition
to greater use of these drugs, researchers suggest that this preoperative
drug therapy has the potential for being a new and useful indicator
for quality improvement assessment in bypass surgery.
These findings on the
effects of beta blocker use in bypass surgery are consistent with
those previously identified for beta blockers when used before noncardiac
surgery or percutaneous coronary intervention (to restore normal
blood flow to plaque-narrowed cardiac arteries).
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