In This Edition
- Statin and beta-blocker use reduces probability of long-term mortality after vascular surgery.
- Low-probability clinical assessment does not exclude pulmonary embolism.
- Upper-extremity DVT is increasing and warrants more aggressive treatment.
- Intensive clinical case management reduces length of hospital stay in CAP.
- Daily chest radiographs have low diagnostic and therapeutic value in the ICU.
- CDAD is associated with high 30-day mortality rate in the ICU setting.
- Frequent nocturnal hemodialysis reduces left ventricular mass and blood pressure.
- Glycemic control in hospitalized patients remains suboptimal.
- Carvedilol fails to show benefit for children with heart failure.
Background: Mortality for vascular surgery remains high. Considering promising new data on use of perioperative statins, the question is, does use of statins and/or beta-blockers within 30 days of surgery reduce long-term mortality? Long-term post-operative mortality has not commonly been reported.
Study design: A retrospective observational cohort study.
Setting: Five Veterans Affairs (VA) medical centers in four western states.
Synopsis: Data were gathered from the regional Department of Veterans Affairs administrative and relational database for the 3,062 patients who had vascular surgery at five VA medical centers from January 1998 to March 2005. All had decreased long-term mortality after vascular surgery when they started taking beta-blockers or statins or both within 30 days before or after surgery, compared with patients taking neither drug. Higher-risk patients benefited the most from combination therapy with statins and beta-blockers, with a 33% reduction in mortality after two years.
Study results were limited by several factors, most related to the study’s retrospective nature. There were differences between users and non-users of statins and beta-blockers. Use of the medications was not random, only 1% of study participants were women, and perhaps most importantly, information regarding tobacco use was available for only 47% of the patients.
Bottom Line: The use of statins and beta-blockers in combination should be considered for all patients undergoing vascular surgery.
Citation: Barrett TW, Mori M, DeBoer D. Association of ambulatory use of statins and beta-blockers with long-term mortality after vascular surgery. J Hosp Med. 2007; 2(4):241-252.