Cost-effectiveness of differing perioperative beta-blockade strategies in vascular surgery patients

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…89 Available data suggest that implementation of various strategies of beta blockade in patients undergoing major vascular surgery is cost-effective and even cost-saving from the perspective of a short-term provider. Fleisher et al 288 used decision analytic techniques to compare 5 different strategies for implementing beta blockade in patients undergoing abdominal aortic aneurysm surgery. These ranged from 1) no routine beta blockade to 2) oral bisoprolol 7 days preoperatively followed by perioperative intravenous metoprolol and oral bisoprolol, 3) immediate preoperative atenolol with postoperative intravenous then oral atenolol, 4) intraoperative esmolol with conversion to intravenous and then oral atenolol in the immediate postoperative period, and 5) intraoperative and postoperative (at 18 hours) esmolol followed by atenolol.…”

“…Further studies in this area are welcomed. The implementation of various strategies of beta blockade in patients undergoing major vascular surgery is cost-effective and even cost-saving from a short-term provider perspective, 288 yet the efficacy and cost-effectiveness of various medical therapies for specific subsets of patients (eg, the role of beta blockers in those patients without a positive stress test) are unknown.…”

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…284,285 However, none of these studies included a strategy of selected screening followed by aggressive beta-blocker treatment in high-risk individuals, as described by Poldermans et al 88 Available data suggest that implementation of various strategies of beta blockade in patients undergoing major vascular surgery is cost-effective and even cost-saving from the perspective of a short-term provider. Fleisher et al 286 used decision analytic techniques to compare 5 different strategies for implementing beta blockade in patients undergoing abdominal aortic aneurysm surgery. These ranged from 1) no routine beta blockade to 2) oral bisoprolol 7 days preoperatively followed by perioperative intravenous metoprolol and oral bisoprolol, 3) immediate preoperative atenolol with postoperative intravenous then oral atenolol, 4) intraoperative esmolol with conversion to intravenous and then oral atenolol in the immediate postoperative period, and 5) intraoperative and postoperative (at 18 hours) esmolol followed by atenolol.…”

Perioperative Strategien zur Regulierung des Sympathikotonus

“…Klinische Studien zu Indikationen außerhalb der perioperativen Kardioprotektion lassen die Vermutung zu, dass Bisoprolol gegenüber Atenolol in seiner kardioprotektiven Wirkung möglicherweise überlegen ist [24]. Im klinischen Einzelfall werden die spezifischen Umstände im Wesentlichen das Vorgehen bestimmen (z.…”

“…Vielleicht kann die Inzidenz der kardiovaskulären Ereignisse nicht mehr stark beeinflusst werden, wohl aber ihr Ausmaß (Herzinfarktgröße, Arrhythmien, Infarktmortalität). Wichtig ist, dass Patienten mit Diabetes mellitus, COPD oder kompensierter Herzinsuffizienz bei vorsichtiger Titration und sorgfältiger Überwachung für die kurze perioperative Zeitspanne eine perioperative β-Blockade mit einem β  -selektiven β-AA in den meisten Fällen gut tolerieren [24]. Auf keinen Fall sollten β-AA bei klinisch dekompensierter Herzinsuffizienz zum Einsatz kommen.…”