In the long-awaited DECREASE IV trial, 1066 intermediate risk (1-6% risk of peri-operative cardiac risk) patients undergoing elective non-cardiac surgery were initiated on bisoprolol 2.5 mg (goal HR 50-70 and SBP>100) +/- fluvastatin 80mg, a month before surgery. Bisoprolol was associated with a lower risk of 30 day cardiac death/MI (2% versus 6%), as was fluvastatin (3% versus 5%; but not statistically significant). There does appear to be a benefit to beta blockers in intermediate risk patients undergoing non-cardiac surgery, if started a month in advance and titrated to goal (abstract). This is different than the POISE trial, in which beta blockers were started immediately before surgery (which showed lowered rates of MI, but higher rates of mortality). For now, there does not appear to be a signficant advantage for statins in reducing peri-operative events.
“We are playing the same sport, but a different game,” the wise, thoughtful emergency medicine attending physician once told me. “I am playing speed chess – I need to make a move quickly, or I lose – no matter what. My moves have to be right, but they don’t always necessarily need to be the […]
With great successes in hosting our first couple of Twitter chats over the last six months, we’re excited to bring you the third in our quarterly series, #JHMChat, where you ask Journal of Hospital Medicine (JHM) authors about their research and corresponding clinical implications for managing inpatient care. We invite you to join us for […]
Kurt Pfeifer, MD, FACP, FHM Does the phrase “medical clearance” make your skin crawl? Perioperative medicine continues to be a growing part of the practice of hospitalists everywhere, yet for many this is an area they feel uncomfortable with. Never fear! Hospital Medicine 2016 has more perioperative medicine educational offerings than ever! On Sunday, March […]