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Heartbeat: Highlights from the issue
  1. Catherine M Otto
  1. Correspondence to
    Professor Catherine M Otto, Division of Cardiology, University of Washington, Seattle, WA 98195, USA; cmotto{at}

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In this issue of Heart, Dr. Bouri and colleagues (see page 456) reexamined the issue of the perioperative use of beta blockers in patients with an intermediate or high cardiovascular risk who are undergoing major non cardiac surgery. Unfortunately, the evidence base for current recommendations has been called into question because of allegations of research fraud in some of the main studies, which are excluded from this new meta-analysis of the relevant randomized controlled clinical trials. They found that although beta-blockers decreased the risk of non-fatal myocardial infarction, they increased the risk of stroke and hypotension with an overall 27% increase in mortality associated with initiation of beta blocker therapy before noncardiac surgery (see figure 1).

Figure 1

Meta-analysis of nine secure randomised controlled trials showing a significant increase in mortality with perioperative β-blockade.

In an accompanying editorial, Drs. Vaishnava and Eagle argue that the final answer is not yet in. Other analyses of the pooled published data indicate that beta blockers may be beneficial. In addition, this meta-analysis does not apply to patients who are …

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