Physicians should rein in their routine use of pre-operative stress tests and beta blockers for patients undergoing non-cardiac surgery, suggest University of Michigan researchers.

Routinely ordering stress tests for patients at a low risk of cardiac events undergoing, for example, gall bladder surgery or hip replacement, "provides no incremental diagnostic yield," write researchers led by Kim Eagle, MD, director of the university's Cardiovascular Center, in a paper to be published in the Annals of Internal Medicine. They also conclude that "indiscriminate perioperative therapy with ??-blockers can increase mortality in otherwise stable patients."

The authors endorse following perioperative guidelines from the American College of Cardiology and American Heart Association, which were recently updated to endorse a less aggressive use of beta blockers in non-cardiac surgical patients who aren't already taking the drugs. ACA/AHA say the update was prompted in part by a study showing "that routine administration of high-dose beta blockers in the absence of dose titration is not useful and may be harmful to beta-blocker-naive patients undergoing surgery."

Instead of indiscriminately prescribing these drugs to patients in the days immediately before surgery, the organizations advise physicians to prescribe beta blockers, where appropriate, days to weeks before elective surgery and to titrate the dosage up as the patient's blood pressure and heart rate will allow, thereby increasing the drug's benefit and decreasing the risk of hypotension and bradycardia. Patients already taking beta blockers should continue taking them perioperatively, according to the guidelines.

Irene Tsikitas