ACC, ESC no longer recommend beta blockers for noncardiac surgery patients

Previous recommendations based on ‘fictitious’ & flawed data

Beta-blockers are considered cardioprotective and are prescribed by many for patients scheduled to undergo noncardiac surgery.

This recommendation and prevalent practice was reviewed following the fraud scandal of Dutch cardiovascular researcher Dr. Don Polderman which put the credibility of several of his published works on perioperative beta-blockade into question. Several cardiovascular societies re-evaluated their guidelines on perioperative evaluation and treatment of noncardiac surgery patients, several of which hinged heavily on Dr. Polderman’s research.

With the findings of newly published trials such as the Perioperative Ischemic Evaluation-2, and the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography (DECREASE) trial, the American College of Cardiology (ACC) and the European Society of Cardiology (ESC) have updated their guidelines and indicated that they do not recommend the routine use of beta- blockers in patients undergoing noncardiac surgery. They also recommend that those who are already taking beta-blockers can continue to do so and that it can be initiated in selected higher-risk patients prior to surgery.

Published in the Journal of the American College of Cardiology and the European Heart Journal, both guidelines further indicate that preoperative initiation of statins may be considered for patients about to undergo vascular surgery, and that those who are already taking it should just continue with it.

Dr. Polderman’s researches suggested that the administration of beta blockers prior to noncardiac surgery significantly reduced cardiac death on the short- and long-term. Dr. Polderman has been accused of using “fictitious data” in order to come up with his study results, carelessness in gathering and preserving essential documentation of data for further verification and analysis, and being unable to obtain informed consent from the study participants. Jose Martin Punzalan with a Journal Watch report

VitalSigns Issue 66 Vol. 3, August 1-31, 2014

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