J Clin Outcomes Manage
Failure to achieve target heart rates during perioperative beta blockade for noncardiac surgery
Kleinman B, Jellish WS, Wall MJ, Vis L
Abstract Objective: To describe a quality assurance project aimed at reducing the incidence of perioperative myocardial infarction and death in patients undergoing noncardiac surgery. Methods: Patients older than age 50 years and undergoing major orthopedic, upper abdominal, major urologic, major vascular, or thoracic surgery received the beta blocker protocol. A total of 762 patients were prescribed beta-blocker therapy in the immediate perioperative period. Results: Despite our intensive effort, we were unable to meet target heart rates (55–65 bpm) in the vast majority of patients. This was especially noted to occur on postoperative days 1 and 2 when fixed-dose administration of beta blocker was utilized. Conclusion: Control of perioperative heart rates is difficult. Failure to reduce the incidence of perioperative myocardial infarction may be related to our inability to effectively control perioperative heart rates
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