Tuesday, November 3, 2009

Updated 2009 ACCF/AHA Guidelines on Perioperative Betablockers

Well, it was just matter of time.

The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have just released their 2009 update on perioperative betablockers.

You can access the update in perioperative betablockers here.

The whole 2009 Perioperative Guidelines (2007 guidelines with the update in perioperative betablockers) is here.

I summarized for you the current indications, and strongly invite you to access the new publications.

Class I indication

  1. Beta blockers should be continued in patients undergoing surgery who are receiving beta blockers for treatment of conditions with ACCF/AHA Class I guideline indications for the drugs. (Level of Evidence: C)

Class IIa indication
  1. Beta blockers titrated to heart rate and blood pressure are probably recommended for patients undergoing vascular surgery who are at high cardiac risk owing to coronary artery disease or the finding of cardiac ischemia on preoperative testing. (Level of Evidence: B)
  2. Beta blockers titrated to heart rate and blood pressure are reasonable for patients in whom
    preoperative assessment for vascular surgery identifies high cardiac risk, as defined by the
    presence of more than 1 clinical risk factor. (Level of Evidence: C)
  3. Beta blockers titrated to heart rate and blood pressure are reasonable for patients in whom
    preoperative assessment identifies coronary artery disease or high cardiac risk, as defined by
    the presence of more than 1 clinical risk factor, who are undergoing intermediate-risk surgery.
    (Level of Evidence: B)
Class IIb indication
  1. The usefulness of beta blockers is uncertain for patients who are undergoing either intermediate risk procedures or vascular surgery in whom preoperative assessment identifies a single clinical risk factor in the absence of coronary artery disease. (Level of Evidence: C)
  2. The usefulness of beta blockers is uncertain in patients undergoing vascular surgery with noclinical risk factors who are not currently taking beta blockers. (Level of Evidence: B)
Class III indication
  1. Beta blockers should not be given to patients undergoing surgery who have absolute
    contraindications to beta blockade. (Level of Evidence: C)
  2. Routine administration of high-dose beta blockers in the absence of dose titration is not useful and may be harmful to patients not currently taking beta blockers who are undergoing noncardiac surgery.8 (Level of Evidence: B)

I hope you find this updates useful. At this point it doesn't change a lot of our current practice, but simply emphasize the cautious approach to avoiding elevated doses of betablockers and a well avoiding starting them without careful uptitration.

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