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New Meta-analysis
The second new development is the publication of a new meta-analysis by Bouri and colleagues which excludes what they regard as 'insecure' studies—namely, DECREASE and DECREASE IV trials from the Erasmus Medical Center. Based on data from nine other clinical trials (10 529 patients), the investigators report that the treatment of patients undergoing non-cardiac surgery and receiving β-blockers according to the existing recommendations of the AACF/AHA or ESC guidelines was subject to a significant 27% increase in the all-cause mortality risk. Translated into figures relevant to the UK, this would imply that the drugs could have resulted in >10 000 surgical deaths per year had guidelines been strictly followed! In addition, their use may be associated with a 73% increase in the incidence of non-fatal stroke, and 51% increased incidence of hypotension. On the benefit side, there was a 27% reduction in non-fatal myocardial infarction. If we return to the analysis of Bangalore and colleagues, they show similar outcomes, where any benefit of β-blockade is driven by trials with a high intrinsic risk for bias—namely, DECREASE and DECREASE IV.
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