How strong is the evidence for the use of perioperative β blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials

P. J. Devereaux, W. Scott Beattie, Peter T L Choi, Neal H. Badner, Gordon H. Guyatt, Juan C. Villar, Claudio S. Cinà, Kate Leslie, Michael J. Jacka, Victor Manuel Montori, Mohit Bhandari, Alvaro Avezum, Alexandre B. Cavalcanti, Julian W. Giles, Thomas Schricker, Homer Yang, Carl Johan Jakobsen, Salim Yusuf

Research output: Contribution to journalArticle

354 Citations (Scopus)

Abstract

Objective: To determine the effect of perioperative β blocker treatment in patients having non-cardiac surgery. Design: Systematic review and meta-analysis. Data sources: Seven search strategies, including searching two bibliographic databases and hand searching seven medical journals. Study selection and outcomes: We included randomised controlled trials that evaluated β blocker treatment in patients having non-cardiac surgery. Perioperative outcomes within 30 days of surgery included total mortality, cardiovascular mortality, non-fatal myocardial infarction, non-fatal cardiac arrest, non-fatal stroke, congestive heart failure, hypotension needing treatment, bradycardia needing treatment, and bronchospasm. Results: Twenty two trials that randomised a total of 2437 patients met the eligibility criteria. Perioperative β blockers did not show any statistically significant beneficial effects on any of the individual outcomes and the only nominally statistically significant beneficial relative risk was 0.44 (95% confidence interval 0.20 to 0.97, 99% confidence interval 0.16 to 1.24) for the composite outcome of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal cardiac arrest. Methods adapted from formal interim monitoring boundaries applied to cumulative meta-analysis showed that the evidence failed, by a considerable degree, to meet standards for forgoing additional studies. The individual safety outcomes in patients treated with perioperative β blockers showed a relative risk for bradycardia needing treatment of 2.27 (95% CI 1.53 to 3.36, 99% CI 1.36 to 3.80) and a nominally statistically significant relative risk for hypotension needing treatment of 1.27 (95% CI 1.04 to 1.56, 99% CI 0.97 to 1.66). Conclusion: The evidence that perioperative β blockers reduce major cardiovascular events is encouraging but too unreliable to allow definitive conclusions to be drawn.

Original languageEnglish (US)
Pages (from-to)313-316
Number of pages4
JournalBritish Medical Journal
Volume331
Issue number7512
DOIs
StatePublished - Aug 6 2005

Fingerprint

Meta-Analysis
Randomized Controlled Trials
Bradycardia
Heart Arrest
Hypotension
Mortality
Therapeutics
Myocardial Infarction
Bibliographic Databases
Confidence Intervals
Bronchial Spasm
Information Storage and Retrieval
Ambulatory Surgical Procedures
Heart Failure
Stroke
Outcome Assessment (Health Care)
Safety

ASJC Scopus subject areas

  • Medicine(all)

Cite this

How strong is the evidence for the use of perioperative β blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials. / Devereaux, P. J.; Beattie, W. Scott; Choi, Peter T L; Badner, Neal H.; Guyatt, Gordon H.; Villar, Juan C.; Cinà, Claudio S.; Leslie, Kate; Jacka, Michael J.; Montori, Victor Manuel; Bhandari, Mohit; Avezum, Alvaro; Cavalcanti, Alexandre B.; Giles, Julian W.; Schricker, Thomas; Yang, Homer; Jakobsen, Carl Johan; Yusuf, Salim.

In: British Medical Journal, Vol. 331, No. 7512, 06.08.2005, p. 313-316.

Research output: Contribution to journalArticle

Devereaux, PJ, Beattie, WS, Choi, PTL, Badner, NH, Guyatt, GH, Villar, JC, Cinà, CS, Leslie, K, Jacka, MJ, Montori, VM, Bhandari, M, Avezum, A, Cavalcanti, AB, Giles, JW, Schricker, T, Yang, H, Jakobsen, CJ & Yusuf, S 2005, 'How strong is the evidence for the use of perioperative β blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials', British Medical Journal, vol. 331, no. 7512, pp. 313-316. https://doi.org/10.1136/bmj.38503.623646.8F
Devereaux, P. J. ; Beattie, W. Scott ; Choi, Peter T L ; Badner, Neal H. ; Guyatt, Gordon H. ; Villar, Juan C. ; Cinà, Claudio S. ; Leslie, Kate ; Jacka, Michael J. ; Montori, Victor Manuel ; Bhandari, Mohit ; Avezum, Alvaro ; Cavalcanti, Alexandre B. ; Giles, Julian W. ; Schricker, Thomas ; Yang, Homer ; Jakobsen, Carl Johan ; Yusuf, Salim. / How strong is the evidence for the use of perioperative β blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials. In: British Medical Journal. 2005 ; Vol. 331, No. 7512. pp. 313-316.
@article{a703ba53d85d4aefa6fdadfb47eec3aa,
title = "How strong is the evidence for the use of perioperative β blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials",
abstract = "Objective: To determine the effect of perioperative β blocker treatment in patients having non-cardiac surgery. Design: Systematic review and meta-analysis. Data sources: Seven search strategies, including searching two bibliographic databases and hand searching seven medical journals. Study selection and outcomes: We included randomised controlled trials that evaluated β blocker treatment in patients having non-cardiac surgery. Perioperative outcomes within 30 days of surgery included total mortality, cardiovascular mortality, non-fatal myocardial infarction, non-fatal cardiac arrest, non-fatal stroke, congestive heart failure, hypotension needing treatment, bradycardia needing treatment, and bronchospasm. Results: Twenty two trials that randomised a total of 2437 patients met the eligibility criteria. Perioperative β blockers did not show any statistically significant beneficial effects on any of the individual outcomes and the only nominally statistically significant beneficial relative risk was 0.44 (95{\%} confidence interval 0.20 to 0.97, 99{\%} confidence interval 0.16 to 1.24) for the composite outcome of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal cardiac arrest. Methods adapted from formal interim monitoring boundaries applied to cumulative meta-analysis showed that the evidence failed, by a considerable degree, to meet standards for forgoing additional studies. The individual safety outcomes in patients treated with perioperative β blockers showed a relative risk for bradycardia needing treatment of 2.27 (95{\%} CI 1.53 to 3.36, 99{\%} CI 1.36 to 3.80) and a nominally statistically significant relative risk for hypotension needing treatment of 1.27 (95{\%} CI 1.04 to 1.56, 99{\%} CI 0.97 to 1.66). Conclusion: The evidence that perioperative β blockers reduce major cardiovascular events is encouraging but too unreliable to allow definitive conclusions to be drawn.",
author = "Devereaux, {P. J.} and Beattie, {W. Scott} and Choi, {Peter T L} and Badner, {Neal H.} and Guyatt, {Gordon H.} and Villar, {Juan C.} and Cin{\`a}, {Claudio S.} and Kate Leslie and Jacka, {Michael J.} and Montori, {Victor Manuel} and Mohit Bhandari and Alvaro Avezum and Cavalcanti, {Alexandre B.} and Giles, {Julian W.} and Thomas Schricker and Homer Yang and Jakobsen, {Carl Johan} and Salim Yusuf",
year = "2005",
month = "8",
day = "6",
doi = "10.1136/bmj.38503.623646.8F",
language = "English (US)",
volume = "331",
pages = "313--316",
journal = "The BMJ",
issn = "0959-8146",
publisher = "BMJ Publishing Group",
number = "7512",

}

TY - JOUR

T1 - How strong is the evidence for the use of perioperative β blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials

AU - Devereaux, P. J.

AU - Beattie, W. Scott

AU - Choi, Peter T L

AU - Badner, Neal H.

AU - Guyatt, Gordon H.

AU - Villar, Juan C.

AU - Cinà, Claudio S.

AU - Leslie, Kate

AU - Jacka, Michael J.

AU - Montori, Victor Manuel

AU - Bhandari, Mohit

AU - Avezum, Alvaro

AU - Cavalcanti, Alexandre B.

AU - Giles, Julian W.

AU - Schricker, Thomas

AU - Yang, Homer

AU - Jakobsen, Carl Johan

AU - Yusuf, Salim

PY - 2005/8/6

Y1 - 2005/8/6

N2 - Objective: To determine the effect of perioperative β blocker treatment in patients having non-cardiac surgery. Design: Systematic review and meta-analysis. Data sources: Seven search strategies, including searching two bibliographic databases and hand searching seven medical journals. Study selection and outcomes: We included randomised controlled trials that evaluated β blocker treatment in patients having non-cardiac surgery. Perioperative outcomes within 30 days of surgery included total mortality, cardiovascular mortality, non-fatal myocardial infarction, non-fatal cardiac arrest, non-fatal stroke, congestive heart failure, hypotension needing treatment, bradycardia needing treatment, and bronchospasm. Results: Twenty two trials that randomised a total of 2437 patients met the eligibility criteria. Perioperative β blockers did not show any statistically significant beneficial effects on any of the individual outcomes and the only nominally statistically significant beneficial relative risk was 0.44 (95% confidence interval 0.20 to 0.97, 99% confidence interval 0.16 to 1.24) for the composite outcome of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal cardiac arrest. Methods adapted from formal interim monitoring boundaries applied to cumulative meta-analysis showed that the evidence failed, by a considerable degree, to meet standards for forgoing additional studies. The individual safety outcomes in patients treated with perioperative β blockers showed a relative risk for bradycardia needing treatment of 2.27 (95% CI 1.53 to 3.36, 99% CI 1.36 to 3.80) and a nominally statistically significant relative risk for hypotension needing treatment of 1.27 (95% CI 1.04 to 1.56, 99% CI 0.97 to 1.66). Conclusion: The evidence that perioperative β blockers reduce major cardiovascular events is encouraging but too unreliable to allow definitive conclusions to be drawn.

AB - Objective: To determine the effect of perioperative β blocker treatment in patients having non-cardiac surgery. Design: Systematic review and meta-analysis. Data sources: Seven search strategies, including searching two bibliographic databases and hand searching seven medical journals. Study selection and outcomes: We included randomised controlled trials that evaluated β blocker treatment in patients having non-cardiac surgery. Perioperative outcomes within 30 days of surgery included total mortality, cardiovascular mortality, non-fatal myocardial infarction, non-fatal cardiac arrest, non-fatal stroke, congestive heart failure, hypotension needing treatment, bradycardia needing treatment, and bronchospasm. Results: Twenty two trials that randomised a total of 2437 patients met the eligibility criteria. Perioperative β blockers did not show any statistically significant beneficial effects on any of the individual outcomes and the only nominally statistically significant beneficial relative risk was 0.44 (95% confidence interval 0.20 to 0.97, 99% confidence interval 0.16 to 1.24) for the composite outcome of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal cardiac arrest. Methods adapted from formal interim monitoring boundaries applied to cumulative meta-analysis showed that the evidence failed, by a considerable degree, to meet standards for forgoing additional studies. The individual safety outcomes in patients treated with perioperative β blockers showed a relative risk for bradycardia needing treatment of 2.27 (95% CI 1.53 to 3.36, 99% CI 1.36 to 3.80) and a nominally statistically significant relative risk for hypotension needing treatment of 1.27 (95% CI 1.04 to 1.56, 99% CI 0.97 to 1.66). Conclusion: The evidence that perioperative β blockers reduce major cardiovascular events is encouraging but too unreliable to allow definitive conclusions to be drawn.

UR - http://www.scopus.com/inward/record.url?scp=23444449308&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=23444449308&partnerID=8YFLogxK

U2 - 10.1136/bmj.38503.623646.8F

DO - 10.1136/bmj.38503.623646.8F

M3 - Article

C2 - 15996966

AN - SCOPUS:23444449308

VL - 331

SP - 313

EP - 316

JO - The BMJ

JF - The BMJ

SN - 0959-8146

IS - 7512

ER -