Factors associated with mortality when chronic betablocker therapy is withdrawn in the peri-operative period in vascular surgical patients: a matched case-control study.

B M Biccard

Abstract readComparative Study

In one paragraph

Article in Cardiovascular journal of Africa. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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B M BiccardDepartment of Anaesthetics, Nelson R Mandela School of Medicine and Inkosi Albert Luthuli Central Hospital, Durban, South Africa. biccardb@ukzn.ac.za

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6 · The paper itself

Abstract

backgroundWithdrawal of chronic beta-blockade following vascular surgery is associated with peri-operative mortality. The aim of this study was to examine risk factors associated with mortality in patients where chronic beta-blockade was withdrawn.

methodsTwo matched case-control studies were conducted, one of patients withdrawn from beta-blockade who survived and the other of patients who were maintained on beta-blockade and survived. Each case was matched with two controls. Three potential risk factors were analysed: the increase in heart rate postoperatively, the use of inotropes, and whether withdrawal for the first three postoperative days was more predictive than withdrawal for a single day. Multivariate conditional logistic regression was conducted.

resultsThe only independent predictor of in-hospital mortality was a change in the mean daily heart rate of > or = six beats per minute from the day of surgery to the third postoperative day, or death or discharge if this happened before the third day (OR 13.7, 95% CI: 1.7-110, p = 0.014). The area under the curve for the receiver operating characteristic curve was 0.787.

conclusionUse of a postoperative heart rate threshold may be clinically useful as an 'early warning system' in patients withdrawn from chronic beta-blockade in the peri-operative period.

Indexed as

Vascular Surgical ProceduresWithholding TreatmentAdrenergic beta-AntagonistsAdultFemaleHeart DiseasesHospital MortalityHumansMaleMiddle AgedPreoperative CarePreoperative PeriodRetrospective StudiesRisk FactorsSouth AfricaSurvival RateAdrenergic beta-Antagonists

Identifiers

PMID20532434

PMCPMC3721290

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