ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Thursday, December 5, 1996 TAG: 9612050022
SECTION: NATL/INTL PAGE: A-1 EDITION: METRO
DATELINE: BOSTON
SOURCE: Associated Press
Routinely giving a heart-slowing medicine to surgery patients with bad hearts appears to cut their death rate in half and could save as many as 300,000 lives a year, researchers say.
About 30 million Americans undergo surgery each year, and heart attacks are a common complication in the months afterward, especially for the 3 million who already have underlying coronary artery disease.
Doctors at the San Francisco Veterans Affairs Medical Center theorized they could cut this risk by protecting the heart from the physical stress of an operation.
To test the idea, they gave a medicine called a beta blocker, one of the most widely prescribed heart drugs, to surgery patients with suspected heart disease. The results were so dramatic, even the researchers were surprised.
After two years of follow-up, 10 percent of the patients getting the drug had died. Of the group that didn't receive the drug, 21 percent died.
The lead researcher said the findings are so clear that doctors should immediately make this drug - an older, generic type of beta blocker called atenolol - a routine part of treatment after operations.
``I believe this is a mandate for changing practice,'' said Dr. Dennis Mangano of the San Francisco Veterans Affairs Medical Center.
Some doctors not involved in the study were more cautious. They worried that because of the study's relatively small size - 200 people - the apparent benefit could have been a matter of chance.
``This really has potentially great importance,'' said Dr. Jay Cohn of the University of Minnesota. ``However, it is too small a trial to change practice based on this single study.''
The study, paid for by the Ischemia Research and Education Foundation of San Francisco, is published in today's issue of the New England Journal of Medicine.
The volunteers were equally divided between those who got atenolol for four to seven days after surgery and those who received placebos. During the first six months after release from the hospital, none of those who took atenolol died, compared with 8 percent in the comparison group. After one year, the death rate was 3 percent in the atenolol patients and 14 percent among the others.
The main effect of the treatment was in reducing deaths from heart disease. Those getting the medicine suffered only half as many heart attacks and other serious heart problems, such as congestive heart failure and severe angina pain.
The treatment was, by medical standards, cheap: less than $100 per patient.
If the drug truly works as well as the study suggests, it could save the lives of 10 percent of the 3 million people with heart trouble who have surgery each year, or 300,000 lives.
Mangano found that people's hearts often race at 100 to 110 beats per minute for several days after they have operations. For those who have clogged arteries, their hearts may not get enough oxygen to keep this up.
``Surgery is the most profound stress that a person can experience in a lifetime,'' he said. ``It's like taking a high-risk patient and having them run a series of marathons.''
Beta blockers lower the heartbeat by muting the body's response to the hormones that are produced in times of mental and physical stress.
The doctors found the beta blocker could be given safely without raising patients' risk of low blood pressure or other complications.
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