An update to guidelines from the American College of Cardiology and American Heart Association for patients scheduled for cardiovascular surgery says beta-blocker therapy should start in advance of the surgery date:

Surgery patients who are already taking beta-blockers should not have their dose titrated up on the day of surgery, according to the update, published online by the Journal of the American College of Cardiology and Circulation, Journal of the American Heart Association.

Standard practice for cardiovascular surgery had been to initiate beta-blocker therapy on the day of the procedure or to pump up the dose right before it in order to minimize cardiovascular risks associated with the stress of surgery.

But data from the POISE trial (Perioperative Ischemic Evaluation), prompted the ACC/AHA to revisit the issue, according to Kirsten E. Fleischmann, MD, MPH, who chaired the group that drafted the update.

Fleischmann said the new guidelines do not alter the current recommendation to continue beta-blockers perioperatively in those patients who are already receiving them.

Fleischman added that “guidelines do not advocate for routine administration of beta-blockers, particularly in higher fixed-dose regimens, begun on the day of surgery based on data from the POISE study.”

<>Primary source: Journal of the American College of Cardiology