The 30-day myocardial infarction and mortality rate was significantly higher (2.74% v. 0.7%) in patients who got beta blockers in conjunction with noncardiac surgery, according to an article in the October 2008 issue of Archives of Surgery (Kaafarani HMA. Arch Surg 2008;143:940-944).
This paper adds to the finding of the POISE study (Perioperative Ischemic Evaluation Trial) of more than 8,000 patients undergoing noncardiac surgery, which was published in the May issue of the Lancet. Although there were fewer MIs in the group receiving extended-release metoprolol, all-cause mortality and disabling strokes were significantly more likely in that group (MedScape 10/29/08).
The authors’ interpretation was: “Our results highlight the risk in assuming a perioperative beta-blocker regimen has benefit without substantial harm, and the importance and need for large randomised trials in the perioperative setting. Patients are unlikely to accept the risks associated with perioperative extended-release metoprolol” (Lancet 2008: 71:1839-1847).
AAPS President Mark Kellen, M.D., comments that these studies illustrate the danger of centralized control of medicine, with instant reporting to bureacurats through electronic records and pay for “performance” (meaning compliance with “guidelines”).
“In a system where physicians are independent clinicians paid by patients and not third parties, information is slowly incorporated into our practices, putting only a few patients at a time at risk of complications from new medicines and procedures,” he states.
In contrast, “national guidelines can easily be prone to overtreatment, given the bias for publishing favorable studies about a drug or treatment over negative studies or studies showing harm. Immense amounts of money can change hands with the recommendation to use a certain treatment.”
With centralized control, decisions about the “standard of care” could be implemented in a very short time, with potentially disastrous results for millions of patients.
- “Pay for Performance in Perspective” by Robert P. Gervais, M.D., J Am Phys Surg, Spring 2006.
- “Pay for Performance or Pay for Compliance?” by Richard O. Dolinar, M.D., 2006.
- “Pay for Performance,” AAPS News, September 2004.
- Tags: Pay for performance