• S E Hoeks, W J M Scholte Op Reimer, H van Urk, P J G Jörning, E Boersma, M L Simoons, J J Bax, and D Poldermans.
• Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands.
• Eur J Vasc Endovasc Surg. 2007 Jan 1;33(1):13-9.

ObjectivesTo assess the relation between beta-blocker use, underlying cardiac risk, and 1-year outcome in vascular surgery patients, including the effect of beta-blocker withdrawal.DesignProspective survey.Materials711 consecutive peripheral vascular surgery patients from 11 hospitals in the Netherlands between May and December 2004.MethodsPatients were evaluated for cardiac risk factors, beta-blocker use and 1-year mortality. Low and high risk was defined according to the Revised Cardiac Risk Index. Propensity scores for the likelihood of beta-blocker use were calculated and regression models were used to study the relation between beta-blocker use and mortality.Results285 patients (40%) received beta-blockers throughout the perioperative period (continuous users). Only 52% of the 281 high risk patients received continuous beta-blocker therapy. Beta-blocker therapy was started in 29 and stopped in 21 patients, respectively. One-year mortality was 11%. After adjustment for potential confounders and the propensity of its use, continuous beta-blocker use remained significantly associated with a lower 1-year mortality compared to non-users (HR=0.4; 95%CI=0.2-0.7). In contrast, beta-blocker withdrawal was associated with an increased risk of 1-year mortality compared to non-users (HR=2.7; 95%CI=1.2-5.9).ConclusionsWe demonstrated an under-use of beta-blockers in vascular surgery patients, even in high-risk patients. Perioperative beta-blocker use was independently associated with a lower risk of 1-year mortality compared to non-use, while perioperative withdrawal of beta-blocker therapy was associated with a higher 1-year mortality.

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