Preoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metric

Abstract Background The use of preoperative beta-blockers has been accepted as a quality standard for patients undergoing coronary artery bypass graft (CABG) surgery. However, conflicting results from recent studies have raised questions concerning the effectiveness of this quality metric. We sought...

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Autores principales:	Hanwei Tang, Kai Chen, Jianfeng Hou, Xiaohong Huang, Sheng Liu, Shengshou Hu
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Beta-blocker Quality metric Coronary artery bypass grafting Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/4971b609ddbc4c449f47eabf5e383dc6
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spelling	oai:doaj.org-article:4971b609ddbc4c449f47eabf5e383dc62021-11-21T12:04:13ZPreoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metric10.1186/s12872-021-02371-11471-2261https://doaj.org/article/4971b609ddbc4c449f47eabf5e383dc62021-11-01T00:00:00Zhttps://doi.org/10.1186/s12872-021-02371-1https://doaj.org/toc/1471-2261Abstract Background The use of preoperative beta-blockers has been accepted as a quality standard for patients undergoing coronary artery bypass graft (CABG) surgery. However, conflicting results from recent studies have raised questions concerning the effectiveness of this quality metric. We sought to determine the influence of preoperative beta-blocker administration before CABG in patients with left ventricular dysfunction. Methods The authors analyzed all cases of isolated CABGs in patients with left ventricular ejection fraction less than 50%, performed between 2012 January and 2017 June, at 94 centres recorded in the China Heart Failure Surgery Registry database. In addition to the use of multivariate regression models, a 1–1 propensity scores matched analysis was performed. Results Of 6116 eligible patients, 61.7% received a preoperative beta-blocker. No difference in operative mortality was found between two cohorts (3.7% for the non-beta-blockers group vs. 3.0% for the beta-blocker group; adjusted odds ratio [OR] 0.82 [95% CI 0.58–1.15]). Few differences in the incidence of other postoperative clinical end points were observed as a function of preoperative beta-blockers except in stroke (0.7% for the non-beta-blocker group vs. 0.3 for the beta-blocker group; adjusted OR 0.39 [95% CI 0.16–0.96]). Results of propensity-matched analyses were broadly consistent. Conclusions In this study, the administration of beta-blockers before CABG was not associated with improved operative mortality and complications except the incidence of postoperative stroke in patients with left ventricular dysfunction. A more granular quality metric which would guide the use of beta-blockers should be developed.Hanwei TangKai ChenJianfeng HouXiaohong HuangSheng LiuShengshou HuBMCarticleBeta-blockerQuality metricCoronary artery bypass graftingDiseases of the circulatory (Cardiovascular) systemRC666-701ENBMC Cardiovascular Disorders, Vol 21, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Beta-blocker Quality metric Coronary artery bypass grafting Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Beta-blocker Quality metric Coronary artery bypass grafting Diseases of the circulatory (Cardiovascular) system RC666-701 Hanwei Tang Kai Chen Jianfeng Hou Xiaohong Huang Sheng Liu Shengshou Hu Preoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metric
description	Abstract Background The use of preoperative beta-blockers has been accepted as a quality standard for patients undergoing coronary artery bypass graft (CABG) surgery. However, conflicting results from recent studies have raised questions concerning the effectiveness of this quality metric. We sought to determine the influence of preoperative beta-blocker administration before CABG in patients with left ventricular dysfunction. Methods The authors analyzed all cases of isolated CABGs in patients with left ventricular ejection fraction less than 50%, performed between 2012 January and 2017 June, at 94 centres recorded in the China Heart Failure Surgery Registry database. In addition to the use of multivariate regression models, a 1–1 propensity scores matched analysis was performed. Results Of 6116 eligible patients, 61.7% received a preoperative beta-blocker. No difference in operative mortality was found between two cohorts (3.7% for the non-beta-blockers group vs. 3.0% for the beta-blocker group; adjusted odds ratio [OR] 0.82 [95% CI 0.58–1.15]). Few differences in the incidence of other postoperative clinical end points were observed as a function of preoperative beta-blockers except in stroke (0.7% for the non-beta-blocker group vs. 0.3 for the beta-blocker group; adjusted OR 0.39 [95% CI 0.16–0.96]). Results of propensity-matched analyses were broadly consistent. Conclusions In this study, the administration of beta-blockers before CABG was not associated with improved operative mortality and complications except the incidence of postoperative stroke in patients with left ventricular dysfunction. A more granular quality metric which would guide the use of beta-blockers should be developed.
format	article
author	Hanwei Tang Kai Chen Jianfeng Hou Xiaohong Huang Sheng Liu Shengshou Hu
author_facet	Hanwei Tang Kai Chen Jianfeng Hou Xiaohong Huang Sheng Liu Shengshou Hu
author_sort	Hanwei Tang
title	Preoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metric
title_short	Preoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metric
title_full	Preoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metric
title_fullStr	Preoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metric
title_full_unstemmed	Preoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metric
title_sort	preoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metric
publisher	BMC
publishDate	2021
url	https://doaj.org/article/4971b609ddbc4c449f47eabf5e383dc6
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Preoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metric

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