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Press Release Date: April 30, 2002
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).
Researchers, using an observational study approach, accessed the Society of Thoracic Surgeons' National Adult Cardiac Surgery Database to evaluate the use of beta blockers and health outcomes among 629,877 patients undergoing heart bypass surgery between 1996 and 1999 at 497 U.S. and Canadian hospitals. The JAMA article is titled: "Preoperative B-Blocker Use and Mortality and Morbidity Following CABG Surgery in North America," authored by T. Bruce Ferguson, Jr., M.D., Laura P. Coombs, Ph.D., and Eric D. Peterson, M.D., MPH.
Editor's Notes: For additional information and requests for interviews with Dr. Ferguson, please contact Leslie Capo at (504) 568-4806 or Karen Migdail at (301) 427-1855.
Dr. Ferguson and his co-authors also have an article, "IMA Grafting in the Elderly Patient Undergoing CABG: Room for Process Improvement," in the May 2002 issue of the Journal of Thoracic and Cardiovascular Surgery.
For more information, please contact AHRQ Public Affairs, (301) 427-1364.