Clinical Evidence, Practice Guidelines, and (beta)-Blocker Utilization Before Major Noncardiac Surgery
Circulation: Cardiovascular Quality and Outcomes, 08/03/2012
Continuing Medical Education
Evidence Based Medicine
Wijeysundera DN et al. - After a period characterized by increasing adoption of preoperative (beta)-blockade between 1999 and 2005, prescriptions rates subsequently fell from 2005 to 2010.Methods
- The authors conducted a population-based, time-series analysis (April 1999 to March 2010) among residents of Ontario, Canada (age 66 years and older), to evaluate the influence of research publications and practice guidelines on rates of new (beta)-blocker prescriptions before major elective noncardiac surgery.
- In an analysis of 249 828 procedures, the rate of new (beta)-blocker prescriptions increased from 26.3 per 1000 procedures in April 1999 to 62.7 per 1000 procedures in the first quarter of 2005, after which it decreased to 19.7 per 1000 procedures by March 2010.
- The authors observed a marked decrease in prescriptions (P=0.004) during early 2005, without any preceding publications that raised concerns about perioperative (beta)-blockade.
- There was no change (P=0.98) in prescription rates after the May 2008 publication of a multicenter, randomized trial that showed increased mortality from perioperative (beta)-blockade.
- Prescribing trends remain unchanged after revisions of related practice guidelines in 2002 (P=0.28) and 2006 (P=0.53).