Decision support only. Not medical advice. Consult a licensed clinician before initiating or changing therapy.

Patient 020

61y·female·white·ASCVD 5.1%

1 active reversal flag

  1. Perioperative MedicineHigh

    Perioperative beta-blockers for noncardiac surgery

    Why flagged

    Beta-blocker-naive patient scheduled for noncardiac surgery; acute initiation reversed by POISE 2008 (doubled stroke risk HR 2.17, increased all-cause mortality).

    1. Prior guidance2008

      Routine, acute initiation of beta-blockers immediately prior to noncardiac surgery in patients at risk for cardiovascular events to prevent perioperative MI.

    2. POISE2008

      Metoprolol reduced MI but doubled stroke risk (HR 2.17; 95% CI 1.26-3.74) and increased all-cause mortality (HR 1.33; 95% CI 1.03-1.74) due to hypotension and bradycardia.

    3. Reversal2014

      Guidelines updated

    4. Current recommendation

      2014 ACC/AHA Guidelines: Routine acute initiation of beta-blockers on the day of surgery in beta-blocker-naive patients is strictly not recommended.