This review was conducted to inform ACC/AHA (US) guideline recommendations. Based on the evidence considered, the guideline recommends the following:
• Beta blockers should be continued in patients undergoing surgery who have been on beta blockers chronically
• It is reasonable for the management of beta blockers after surgery to be guided by clinical circumstances, independent of when the agent was started
• In patients with intermediate- or high-risk myocardial ischemia noted in preoperative risk stratification tests, it may be reasonable to begin perioperative beta blockers
• In patients with 3 or more Revised Cardiac Risk Index (RCRI) risk factors (e.g. diabetes mellitus, HF, CAD, renal insufficiency, cerebrovascular accident), it may be reasonable to begin beta blockers before surgery
• In patients with a compelling long-term indication for beta-blocker therapy but no other RCRI risk factors, initiating beta blockers in the perioperative setting as an approach to reduce perioperative risk is of uncertain benefit
• In patients in whom beta-blocker therapy is initiated, it may be reasonable to begin perioperative beta blockers long enough in advance to assess safety and tolerability, preferably more than 1 day before surgery
• Beta-blocker therapy should not be started on the day of surgery