Medical Residents: EBM Review and Practice
During a preoperative evaluation of a 66 year old male for elective non-cardiac surgery you find that he had an MI ten years ago. Since that time the patient has made lifestyle modifications (healthy diet and increased exercise), has a resting heart rate of 72 and has not had any new cardiac problems. He asks you if he should be taking a beta-blocker before surgery because he has heard that people with a history of heart disease should all be on beta blockers when they have surgery. Should preoperative beta blockers be prescribed to prevent perioperative cardiovascular complications?
Worksheet (with tips!)
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- using PICOTT to analyze the scenario;
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P (Patient, population) = 66 year old male, history of heart disease
I (Intervention) = preoperative beta blockers
C (Comparison) = none
O (Outcome) = prevent perioperative cardiac complications
T (Type of Question) = therapy
T (Type of Study) = therapy hierarchy starting with systematic review of randomized trials
Search as entered in PubMed: (preoperative OR perioperative) AND beta blockers AND (prevent OR preventing OR prevention) AND (heart OR cardiac OR cardiovascular) AND (complications OR mortality OR morbidity)
PubMed Search Details: (preoperative[All Fields] OR perioperative[All Fields]) AND ("adrenergic beta-antagonists"[Pharmacological Action] OR "adrenergic beta-antagonists"[MeSH Terms] OR ("adrenergic"[All Fields] AND "beta-antagonists"[All Fields]) OR "adrenergic beta-antagonists"[All Fields] OR ("beta"[All Fields] AND "blockers"[All Fields]) OR "beta blockers"[All Fields]) AND (("Prevent"[Journal] OR "prevent"[All Fields]) OR preventing[All Fields] OR ("prevention and control"[Subheading] OR ("prevention"[All Fields] AND "control"[All Fields]) OR "prevention and control"[All Fields] OR "prevention"[All Fields])) AND (("heart"[MeSH Terms] OR "heart"[All Fields]) OR ("heart"[MeSH Terms] OR "heart"[All Fields] OR "cardiac"[All Fields]) OR ("cardiovascular system"[MeSH Terms] OR ("cardiovascular"[All Fields] AND "system"[All Fields]) OR "cardiovascular system"[All Fields] OR "cardiovascular"[All Fields])) AND (("complications"[Subheading] OR "complications"[All Fields]) OR ("mortality"[Subheading] OR "mortality"[All Fields] OR "mortality"[MeSH Terms]) OR ("epidemiology"[Subheading] OR "epidemiology"[All Fields] OR "morbidity"[All Fields] OR "morbidity"[MeSH Terms]))
Type of Article: Use either the Article Type filter or a Clinical Query search to see if there are Meta-Analysis or Systematic Reviews.
1: Foëx P. Innovations in management of cardiac disease: drugs, treatment strategies and technology. Br J Anaesth. 2017 Dec 1;119(suppl_1):i23-i33. doi: 10.1093/bja/aex327. PubMed PMID: 29161389. 2: Blessberger H, Kammler J, Domanovits H, Schlager O, Wildner B, Azar D, Schillinger M, Wiesbauer F, Steinwender C. Perioperative beta-blockers for preventing surgery-related mortality and morbidity. Cochrane Database Syst Rev. 2014 Sep 18;9:CD004476. doi: 10.1002/14651858.CD004476.pub2. PubMed PMID: 25233038.
3: Bouri S, Shun-Shin MJ, Cole GD, Mayet J, Francis DP. Meta-analysis of secure randomised controlled trials of β-blockade to prevent perioperative death in non-cardiac surgery. Heart. 2014 Mar;100(6):456-64. doi: 10.1136/heartjnl-2013-304262. Epub 2013 Jul 31. Review. PubMed PMID: 23904357; PubMed Central PMCID: PMC3932762.
4: Guay J, Ochroch EA. β-blocking agents for surgery: influence on mortality and major outcomes. A meta-analysis. J Cardiothorac Vasc Anesth. 2013 Oct;27(5):834-44. doi: 10.1053/j.jvca.2013.01.009. Epub 2013 Jun 19. PubMed PMID: 23790500.
Be sure to also read the commentaries linked below the abstracts of these articles.