Harvard Heart Letter

Heart beat: Trial questions beta blockers for all before noncardiac surgery

Heart beat

Trial questions beta blockers for all before noncardiac surgery

Drat those pesky clinical trials. The recommendation that everyone undergoing noncardiac surgery take a beta blocker to protect the heart has been called into question by an international trial showing that a beta blocker may "" we stress the may "" do more harm than good.

Knee and hip replacement, prostate removal, breast surgery, and other operations stress the heart. In their 2007 guidelines for protecting the heart during noncardiac surgery, the American Heart Association and American College of Cardiology recommended taking a beta blocker before the operation and for some time afterward. In May 2008, results of the Perioperative Ischemic Evaluation (POISE) trial were published in The Lancet. POISE included more than 8,000 men and women over age 45 at risk of heart disease. Half were given the beta blocker metoprolol two to four hours before surgery and took the drug for a month afterward; the other half took a placebo.

By 30 days after surgery, fewer people in the beta blocker group had experienced a heart attack, developed atrial fibrillation, or needed surgery or angioplasty to restore blood flow through a blocked artery than in the placebo group (288 vs. 386). But there were more strokes and total deaths in the beta blocker group than there were in the placebo group (170 vs. 116).

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