Perioperative β-Blocker Regimen Boosts Risk of Mortality

Results from another major trial are expected soon that will shed added light on this issue. The Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography (DECREASE)-IV trial has enrolled about 6,000 patients scheduled for noncardiac surgery, and randomized them to treatment with the β-blocker bisoprolol or placebo, and also randomized patients to treatment with fluvastatin or placebo. Unlike POISE, patients in DECREASE-IV could be started on bisoprolol and fluvastatin as much as 30 days before surgery.

A longer titration period and a β-blocker regimen that's stable for several days before surgery might improve outcomes, as might the use of bisoprolol instead of metoprolol, Dr. Don Poldermans, professor of anesthesiology at Erasmus University, Rotterdam, the Netherlands, and senior investigator for DECREASE-IV, said in an interview.