Safe Nurse-led Pre-CTCA Beta-blockade Administration Can Be Achieved Without Intensive Medical Supervision

Abstract

Background: Nurse specialists play an important role in the delivery of CT coronary angiography (CTCA) in the acute chest pain setting. The appropriate dosing of oral and intravenous beta-blockers is crucial. Methods: We prospectively collected data from August 2011 to February 2013 on the use of beta-blockade in patient preparation for CTCA. In our institution, nurse specialists with coronary care unit background administer beta-blockers without immediate hands-on medical supervision. A dosing protocol guides the administration of up to 150 mg oral Metoprolol according to baseline heart rate, but can be varied depending on patient status. Up to 30 mg intravenous Metoprolol is administered at the time of scanning should heart rate control be inadequate. Results: Of the 1104 patients prepared for CTCA, 35 patients (3%) did not proceed due to inadequate heart rate control. The analysis excluded 108 patients on regular beta-blocker and 16 patients who had calcium channel blocker for heart rate control. Protocol adjustments occurred in half the patients, with a lowered Metoprolol dose given in 388 patients (41%). Subsequent IV Metoprolol is more frequent, compared to those given the suggested dosage, (41% vs. 30%, p = 0.0074). Safety is excellent, with rare complications: mild dizziness (1%), hypotension (2%, only one case was symptomatic). Conclusion: Safe pre-CTCA beta-blockade relies heavily on sound clinical judgment of experienced nurse specialists in adjusting the protocol-suggested dosage according to clinical status, but can be achieved without intensive medical supervision.