In the long-awaited DECREASE IV trial, 1066 intermediate risk (1-6% risk of peri-operative cardiac risk) patients undergoing elective non-cardiac surgery were initiated on bisoprolol 2.5 mg (goal HR 50-70 and SBP>100) +/- fluvastatin 80mg, a month before surgery. Bisoprolol was associated with a lower risk of 30 day cardiac death/MI (2% versus 6%), as was fluvastatin (3% versus 5%; but not statistically significant). There does appear to be a benefit to beta blockers in intermediate risk patients undergoing non-cardiac surgery, if started a month in advance and titrated to goal (abstract). This is different than the POISE trial, in which beta blockers were started immediately before surgery (which showed lowered rates of MI, but higher rates of mortality). For now, there does not appear to be a signficant advantage for statins in reducing peri-operative events.
Share This Post
Categories
Related Posts
This article is part of a series in The Hospital Leader written by members of the Division of Hospital Medicine at Dell Medical School at The University of Texas in Austin, exploring lessons learned from the coronavirus pandemic and outlining an approach for creating COVID-19 Centers of Excellence. Patients dying without their loved ones, families […]
Do you have a stack of journals piling up on your desk, beside your bed or in your email inbox? In 1950, medical knowledge was estimated to double every 50 years, but now the doubling time is every few months. At this rate, it is impossible to keep up with the literature, but a group […]
By: Moises Auron, MD, SFHM It is a well-known fact that healthcare expenditure in the United States occupies a large proportion of its gross domestic product, being 17.8% in 2016, which was almost twice to what is expended in other advanced countries; however, this expenditure does not necessarily translate into optimal patient outcomes. In 2012, […]
Leave A Comment