Abstract 2761: Increase of 1-Year Mortality After Perioperative Beta-Blocker Withdrawal in Vascular Surgery Patients
Background: Current ACC/AHA guidelines on perioperative care stress the importance of beta-blockers, especially in high risk patients. The objective of the study was to assess the relation between beta-blocker use, underlying cardiac risk, and one-year outcome in vascular surgery patients. We were specifically interested to learn the effect of discontinuation of beta-blockers.
Methods: Between May and December 2004, 711 consecutive peripheral vascular surgery patients were included in 11 hospitals in the Netherlands and evaluated for cardiac risk factors, beta-blocker use and 1-year mortality. This survey was an integrated part of the infrastructure of the Euro Heart Survey Programme.
Results: In total, 285 patients (40%) received beta-blocker therapy throughout the perioperative period (continuous users). Only 51% of the 146 high risk patients received continuous beta-blocker therapy. Beta-blocker therapy was started in 29 and stopped in 21 patients, respectively. Overall, one-year mortality was 11%. After adjustment for potential confounders and the propensity of its use, continuous beta-blocker use remained significantly associated with a lower 1-year mortality compared to non-users (HR=0.4; 95%CI=0.2– 0.7). In contrast, beta-blocker withdrawal was associated with an increased risk of 1-year mortality compared to non-users (HR=2.6; 95%CI=1.2–5.8).
Conclusion: This study demonstrates an under-use of beta-blockers in vascular surgery patients, even in patients at high cardiac risk. Perioperative beta-blocker use is independently associated with a lower risk of 1-year mortality, while an adverse effect of stopping beta-blocker therapy was observed.