RESUMO
The optimal dosing strategy for perioperative beta-blockers to safely achieve recommended target heart rates (HRs) by current guidelines is not well defined. An HR-titrated perioperative beta-blocker dosing regimen versus a fixed-dose regimen was assessed by clinical outcomes, postoperative heart rate, and beta-blocker-related complications. Patients (n = 64) scheduled to undergo moderate- to high-risk vascular surgery and without contraindications to beta-blockade were randomized to either a fixed-dose or HR-titrated beta-blocker dosing schedule. Clinical outcomes and HRs were followed immediately preoperatively to 24 hr postoperatively. A difference in mean HR between the two dosing arms was significant immediately postoperatively (70.1 vs. 58.2 bpm for fixed dose and HR-titrated arms, respectively; p = 0.012) but at no other time points. However, the HR-titrated strategy led to a significant reduction in the percentage of HR measurements >80 bpm (34.5% vs. 16.1%, p < 0.001) and to a significant reduction in absolute HR change (17.5 vs. 22.5 bpm, p = 0.034). There were no significant differences in the occurrence of asymptomatic hypotension between the two study arms, and no beta-blocker-related adverse events occurred in either study arm. An aggressive, HR-titrated perioperative beta-blocker dosing strategy was associated with more consistent maintenance of postoperative HRs within the range recommended by current guidelines and did not result in increased drug-related adverse events. The question of what is the best perioperative beta-blocker dosing regimen warrants further evaluation in a large-scale clinical trial.
Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Fármacos Cardiovasculares/administração & dosagem , Doenças Cardiovasculares/prevenção & controle , Frequência Cardíaca/efeitos dos fármacos , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Antagonistas Adrenérgicos beta/efeitos adversos , Idoso , Fármacos Cardiovasculares/efeitos adversos , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Esquema de Medicação , Feminino , Humanos , Masculino , Assistência Perioperatória , Guias de Prática Clínica como Assunto , Fatores de Tempo , Resultado do TratamentoRESUMO
Disease associated with the vascular system, including peripheral arterial disease, poses a serious health problem with incidence growing annually. Recognizing this, several health care organizations across the United States have developed programs for public education and community awareness, and for screening individuals at risk for vascular disease. Lehigh Valley Hospital developed and implemented a screening program that evaluated more than 160 individuals during a 12-month period. Results suggest that screening should be limited to patients at high risk; however, the intrinsic value of patient education and patient peace of mind is worth proceeding with the screening effort because patients reported a positive experience.