Document Detail

Heart rate and outcome in patients with cardiovascular disease undergoing major noncardiac surgery.
MedLine Citation:
PMID:  18714616     Owner:  NLM     Status:  MEDLINE    
There is an increasing awareness that an elevated resting heart rate is associated with increased all-cause mortality in the general population and that this may be an independent coronary risk factor This review was undertaken to determine whether heart rate is predictive of increased mortality and major morbidity in noncardiac surgical patients and whether heart rate manipulation improves perioperative outcome. A search of Medline from 1966 until October 2007 was conducted using the terms "heart rate", "surgery", "cardiac", "morbidity", "mortality" and "perioperative". The main findings were that an elevated perioperative heart rate, an absolute increase in heart rate and heart rate lability are independent predictors of both short- and long-term adverse outcomes in patients at cardiovascular risk undergoing major noncardiac surgery. Although prospective nonrandomised and retrospective data suggest heart rate control improves perioperative outcome, there is conflicting evidence from randomised trials that perioperative heart rate control improves outcome. This may be because drug-associated bradycardia influences mortality in the perioperative period. Further studies reporting the absolute heart rate, the absolute change of heart rate and the time period of the observations are needed to identify 'early warning systems', which may allow earlier triage and improved outcome. Enthusiasm for this approach must be tempered by the appreciation that a J-shaped relationship probably exists between heart rate and morbidity, particularly following bradycardic therapy. Therefore, any bradycardic manipulation of heart rate in the perioperative period must be accompanied by simultaneous attention to other physiological variables associated with increased morbidity and mortality.
B M Biccard
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Anaesthesia and intensive care     Volume:  36     ISSN:  0310-057X     ISO Abbreviation:  Anaesth Intensive Care     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-08-21     Completed Date:  2008-12-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0342017     Medline TA:  Anaesth Intensive Care     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  489-501     Citation Subset:  IM    
Department of Anaesthetics, Nelson R. Mandela School of Medicine, Congella, South Africa.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use
Age Factors
Cardiovascular Diseases / physiopathology*
Heart Rate / physiology*
Hospital Mortality
Monitoring, Intraoperative / methods
Myocardial Ischemia / diagnosis,  drug therapy,  physiopathology
Surgical Procedures, Operative / adverse effects,  mortality*
Treatment Outcome
Reg. No./Substance:
0/Adrenergic beta-Antagonists

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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