A recent study suggests that treating a patient with beta-blockers before non-cardiac surgery may increase their likelihood of having a heart attack or dying shortly afterwards.

Haytham M. A. Kaafarani, M.D. and colleagues studied data of 1,238 patients who underwent non-cardiac surgery at a medical center in 2000, of these 238 received beta-blockers perioperatively. These patients were matched by age, sex, cardiac risk, procedure risk, smoking status, and kidney health, to 408 patients who also underwent surgery but did not receive beta-blockers.

Results showed that the incidence of heart attack within the 30 days following surgery was 2.94% in those treated with beta-blockers, compared with 0.74% in those who were not treated with the drugs. Similarly, the incidence of post-surgery death was higher in those treated with beta blockers – 2.5% versus 0.25% in the control group.  

Participants treated with beta-blockers who died were found to have significantly higher heart rates prior to surgery compared to those who survived (86 versus 70 beats/min). The researchers write: “This finding suggests that a low target preoperative rather than intraoperative heart rate is essential for the protective effect of beta-blockers. The relationship between preoperative (rather than intraoperative or postoperative) heart rate and perioperative mortality stresses the importance of not only initiating but also titrating the effect of beta-blockers to an acceptable target heart rate before surgery."

Kaafarani HMA, Atluri PV, Thornby J, Itani KMF. β-Blockade in noncardiac surgery: Outcome at all levels of cardiac risk. Arch Surg. 2008;143(10):940-944.