Our study identified perioperative underutilization of β-blockers in patients with risk for CAD despite their use having been incorporated in the American College of Physicians (ACP) practice guidelines.1 Beattie et al and Marret and Albaladejo raise the question of benefit of perioperative β-blockers in non–high-risk patients and refer to 2 analyses by Auerbach and Goldman2 and Stevens et al3 in support of this. We agree that the benefit of perioperative β-blockers in non–high-risk patients is less clear compared with high-risk patients undergoing major surgical procedures. Clearly, more work needs to be done in this area. However, our study was intended to assess physicians’ concordance with practice guidelines without providing an assessment of the guidelines themselves. In fact, in our article we speculated that based on the available evidence physicians might perceive only a small benefit of β-blockade, which could have contributed to the limited β-blocker use in our study.
Ahmed S, Siddiqui AK, Delbeau H, Mattana J. Are β-Blockers Useful to Protect High-Risk Patients Scheduled for Open Cholecystectomy?—Reply. Arch Intern Med. 2005;165(3):348-349. doi:10.1001/archinte.165.3.348-b