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Impact of Beta‐Blocker Initiation Timing on Mortality Risk in Patients With Diabetes Mellitus Undergoing Noncardiac Surgery: A Nationwide Population‐Based Cohort Study
- Source :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
- Publication Year :
- 2017
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2017.
-
Abstract
- Background Relevant clinical studies have been small and have not convincingly demonstrated whether the perioperative initiation of beta‐blockers should be considered in patients with diabetes mellitus undergoing noncardiac surgery. Methods and Results In this nationwide propensity score–matched study, we included patients with diabetes mellitus undergoing noncardiac surgery between 2000 and 2011 from Taiwan's National Health Insurance Research Database. Patients were classified as beta‐blocker and non–beta‐blocker cohorts. We further stratified beta‐blocker users into cardioprotective beta‐blocker (atenolol, bisoprolol, metoprolol, or carvedilol) and other beta‐blocker users. To investigate time of initiation of beta‐blocker use, initiation time was stratified into 2 periods (>30 and ≤30 days preoperatively). The outcomes of interest were in‐hospital and 30‐day mortality. After propensity score matching, we identified 50 952 beta‐blocker users and 50 952 matched controls. Compared with non–beta‐blocker users, cardioprotective beta‐blocker users were associated with lower risks of in‐hospital (odds ratio 0.75, 95% CI 0.68–0.82) and 30‐day (odds ratio 0.75, 95% CI 0.70–0.81) mortality. Among initiation times, only the use of cardioprotective beta‐blockers for >30 days was associated with decreased risk of in‐hospital (odds ratio 0.72, 95% CI 0.65–0.78) and 30‐day (odds ratio 0.72, 95% CI 0.66–0.78) mortality. Of note, use of other beta‐blockers for ≤30 days before surgery was associated with increased risk of both in‐hospital and 30‐day mortality. Conclusions The use of cardioprotective beta‐blockers for >30 days before surgery was associated with reduced mortality risk, whereas short‐term use of beta‐blockers was not associated with differences in mortality in patients with diabetes mellitus.
- Subjects :
- Male
Time Factors
Databases, Factual
Epidemiology
beta‐blocker
030204 cardiovascular system & hematology
Cohort Studies
Propanolamines
surgery
0302 clinical medicine
Risk Factors
Odds Ratio
Medicine
Hospital Mortality
030212 general & internal medicine
Carvedilol
Original Research
Diabetes, Type 2
Middle Aged
Bisoprolol
Surgical Procedures, Operative
diabetes mellitus
Female
Cardiology and Cardiovascular Medicine
Metoprolol
medicine.drug
medicine.medical_specialty
medicine.drug_class
Adrenergic beta-Antagonists
Carbazoles
Taiwan
Perioperative Care
03 medical and health sciences
Internal medicine
Diabetes mellitus
Humans
Mortality
Propensity Score
Beta blocker
Aged
business.industry
Odds ratio
Perioperative
Protective Factors
medicine.disease
Surgery
Atenolol
Diabetes Mellitus, Type 2
Propensity score matching
business
Subjects
Details
- ISSN :
- 20479980
- Volume :
- 6
- Database :
- OpenAIRE
- Journal :
- Journal of the American Heart Association
- Accession number :
- edsair.doi.dedup.....03c721546e48b35feb68975c972dcfbe