New guideline on β blockers challenges ESC advice

Abstract

Cardiology researchers have produced new independent guidelines in an attempt to replace the disputed European Society of Cardiology (ESC) guidelines on the use of perioperative β blockers in non-cardiac surgery. Contrary to the controversial ESC guidelines, the alternative guidelines published in the International Journal of Cardiology state that “beta-blockade should not be routinely initiated for perioperative protection because trial data indicate an increase in mortality”. The independent guidelines are authored by researchers from Imperial College London, UK. Their earlier meta-analysis published in Heart suggested that the ESC’s recommendations to use β blockers periopeoratively in high-risk patients having non-cardiac surgery could be associated with a 27% increase in mortality. A subsequent commentary which estimated that the guidelines had potentially resulted in hundreds of thousands of excess deaths was pulled from the European Heart Journal (EHJ) website after publication and is yet to be republished. The data on which the ESC guidelines are based have been openly questioned by cardiologists. They are heavily based on the DECREASE trials led by Don Poldermans, the former chair of the ESC perioperative guidelines task force, who was dismissed after an investigation in 2011 found widespread “academic misconduct” and that much of the data had been fabricated. So far only one Poldermans paper has been retracted. Darrel Francis and Graham Cole tell The Lancet: “Our urgent focus remains on making guidelines safe. Many other calculations [of excess mortality] are possible, but time diverted quibbling over a number would be better spent safeguarding patient survival.” They add: “Since our meta-analysis, we have published the [presently] retracted article, drafted a new guideline restricted to reliable trials, and presented a major proposal to the EHJ regarding all future guidelines, to protect patients from recurrences.” This month the EHJ published an editorial in a bid to avoid public “panic”, which warned that “jumping to conclusions may be particularly dangerous for both physicians and patients”. The ESC is currently working on revised guidelines that are due to be published in August.