DOCTOR'S VIEW ARCHIVE
It may be possible to reduce heart complications of surgical operations for patients with known heart disease according to a report (1997) in the aNew England Journal of Medicine (NEJM). Heart medications called beta blockers given to patients with heart (cardiac) disease who are undergoing non-cardiac surgery, improve operative survival.
In a study of 200 patients who underwent non-cardiac surgeries, those who received the beta blockers around the time of surgery, were less likely to die over the next two years than those who received a placebo. Beta blockers, which decrease the heart rate, reduce the demands that surgery places on the heart.
An accompanying Editorial pointed out that it is possible to use a simple preoperative history, physical exam and tests (EKG, etc.) to estimate the risk that surgery would have in causing or adding to heart problems. The risk is highest for patients with prior heart attacks, angina, heart failure, or diabetes mellitus, particularly in older age groups or those with unstable symptoms. These risks are cumulative, so that a patient undergoing non-cardiac surgery with three of these indicators, has a 3-4 times greater chance of suffering a heart attack during or shortly after surgery.
The Editorial also discussed who should receive beta-blockers around the time of surgery. For one, patients who have been taking these medications prior to surgery should continue taking them. Other patients who may benefit include those with evidence of coronary heart disease in the preoperative evaluation. Also, if there is an additional reason to use a beta-blocker, such as high blood pressure (hypertension), then it is probably reasonable to use beta-blockers around the time of surgery. Whether physicians should routinely give beta-blockers to patients with cardiac risk factors, but no signs of underlying coronary disease, remains unclear.
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Another interesting finding was that the use of beta-blockers around the time of surgery seems produce a modest decrease in "cardiac events" over the next two-years after surgery, regardless of whether these medications were used before or after surgery.
The study and accompanying Editorial again demonstrated the need for careful medical evaluation of patients undergoing surgical procedures. As the Editorial noted, "surgical mortality rates are already quite low in those undergoing non-cardiac operations-due to the improvements in surgical, anesthetic and postoperative care."
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