Which beta-blocker should be used for the prevention of postoperative atrial fibrillation in cardiac surgery? A multi-treat
Background: Post-operative atrial fibrillation (POAF) is amongst the most common complications following cardiac surgery. Current guidelines recommend oral beta-blockers as a first-line medication to prevent POAF. However, the ideal choice of beta-blocker is unclear, making a comprehensive review cr...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2016-06-01
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| Series: | The Egyptian Heart Journal |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1110260815300223 |
| _version_ | 1818294462543036416 |
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| author | Mohamed Zeinah Mohamed Elghanam Umbertto Benedetto |
| author_facet | Mohamed Zeinah Mohamed Elghanam Umbertto Benedetto |
| author_sort | Mohamed Zeinah |
| collection | DOAJ |
| description | Background: Post-operative atrial fibrillation (POAF) is amongst the most common complications following cardiac surgery. Current guidelines recommend oral beta-blockers as a first-line medication to prevent POAF. However, the ideal choice of beta-blocker is unclear, making a comprehensive review crucial. We aimed to provide a clinically useful summary of the results of a multiple-treatment meta-analysis of randomized controlled trials (RCT). Methods and Results: A MEDLINE/PubMed search was conducted to identify eligible RCTs. Efficacy (POAF prevention rate) and acceptability (dropout for side effect rate) outcomes were investigated. A frequentist approach to network meta-analysis using the graph-theoretical method was implemented to obtain network estimates. A total of 16 trials were included in the final analysis and 4727 subjects were investigated. Network estimates showed that betaxolol (OR 0.36; 95%CI 0.25–0.52), carvedilol (OR 0.36; 95%CI 0.23–0.58) and sotalol (OR 0.38; 95%CI 0.30–0.50) were more effective than propranolol (OR 0.51; 95%CI 0.27–0.95), metoprolol (OR 0.72; 95%CI 0.58–0.90) and atenolol (OR 0.81; 95%CI 0.42–1.56) in reducing the incidence of POAF when compared to placebo. Amongst beta-blockers investigated, carvedilol showed the best safety profile being associated with the lowest risk of patient dropped out for side effect (OR 1.14; 955CI 0.36–3.61). No evidence of heterogeneity/inconsistency was found in the whole network for both efficacy (P = 0.8) and acceptability (P = 0.4) outcomes. Conclusion: Overall, carvedilol was found to be effective in preventing POAF while maintaining a good safety profile. |
| first_indexed | 2024-12-13T03:32:08Z |
| format | Article |
| id | doaj.art-6826e8a35bfe40009d508699d16386f3 |
| institution | Directory Open Access Journal |
| issn | 1110-2608 |
| language | English |
| last_indexed | 2024-12-13T03:32:08Z |
| publishDate | 2016-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Egyptian Heart Journal |
| spelling | doaj.art-6826e8a35bfe40009d508699d16386f32022-12-22T00:01:08ZengSpringerOpenThe Egyptian Heart Journal1110-26082016-06-01682899610.1016/j.ehj.2015.11.001Which beta-blocker should be used for the prevention of postoperative atrial fibrillation in cardiac surgery? A multi-treatMohamed Zeinah0Mohamed Elghanam1Umbertto Benedetto2Ain Shams University, Cairo, EgyptAin Shams University, Cairo, EgyptOxford Heart Centre, UKBackground: Post-operative atrial fibrillation (POAF) is amongst the most common complications following cardiac surgery. Current guidelines recommend oral beta-blockers as a first-line medication to prevent POAF. However, the ideal choice of beta-blocker is unclear, making a comprehensive review crucial. We aimed to provide a clinically useful summary of the results of a multiple-treatment meta-analysis of randomized controlled trials (RCT). Methods and Results: A MEDLINE/PubMed search was conducted to identify eligible RCTs. Efficacy (POAF prevention rate) and acceptability (dropout for side effect rate) outcomes were investigated. A frequentist approach to network meta-analysis using the graph-theoretical method was implemented to obtain network estimates. A total of 16 trials were included in the final analysis and 4727 subjects were investigated. Network estimates showed that betaxolol (OR 0.36; 95%CI 0.25–0.52), carvedilol (OR 0.36; 95%CI 0.23–0.58) and sotalol (OR 0.38; 95%CI 0.30–0.50) were more effective than propranolol (OR 0.51; 95%CI 0.27–0.95), metoprolol (OR 0.72; 95%CI 0.58–0.90) and atenolol (OR 0.81; 95%CI 0.42–1.56) in reducing the incidence of POAF when compared to placebo. Amongst beta-blockers investigated, carvedilol showed the best safety profile being associated with the lowest risk of patient dropped out for side effect (OR 1.14; 955CI 0.36–3.61). No evidence of heterogeneity/inconsistency was found in the whole network for both efficacy (P = 0.8) and acceptability (P = 0.4) outcomes. Conclusion: Overall, carvedilol was found to be effective in preventing POAF while maintaining a good safety profile.http://www.sciencedirect.com/science/article/pii/S1110260815300223Atrial fibrillationCardiac surgeryBeta blockers |
| spellingShingle | Mohamed Zeinah Mohamed Elghanam Umbertto Benedetto Which beta-blocker should be used for the prevention of postoperative atrial fibrillation in cardiac surgery? A multi-treat The Egyptian Heart Journal Atrial fibrillation Cardiac surgery Beta blockers |
| title | Which beta-blocker should be used for the prevention of postoperative atrial fibrillation in cardiac surgery? A multi-treat |
| title_full | Which beta-blocker should be used for the prevention of postoperative atrial fibrillation in cardiac surgery? A multi-treat |
| title_fullStr | Which beta-blocker should be used for the prevention of postoperative atrial fibrillation in cardiac surgery? A multi-treat |
| title_full_unstemmed | Which beta-blocker should be used for the prevention of postoperative atrial fibrillation in cardiac surgery? A multi-treat |
| title_short | Which beta-blocker should be used for the prevention of postoperative atrial fibrillation in cardiac surgery? A multi-treat |
| title_sort | which beta blocker should be used for the prevention of postoperative atrial fibrillation in cardiac surgery a multi treat |
| topic | Atrial fibrillation Cardiac surgery Beta blockers |
| url | http://www.sciencedirect.com/science/article/pii/S1110260815300223 |
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