Heart rate as a predictor and a therapeutic target of cardiac ischemic complications after non-cardiac surgery. A narrative review

Postoperative cardiac ischemic complications are frequent and strongly associated with postoperative mortality. Elevated heart rate before, during and after surgery increases the risk of postoperative myocardial injury, myocardial infarction and mortality. Yet, in absence of strong causal evidence, heart rate is seldom used for risk stratification. While beta-blockers reduce the risk of tachycardia and myocardial infarction, their initiation within 24 h of surgery is harmful. Rather than a “one-size fits all” approach, we propose that safe and efficient administration of beta blockers should take into account both the perioperative risk and the pharmacogenetic profile of each patient. In the future, new drugs designed to modulate heart rate without significant hypotension (e.g. ivabradine) may replace beta-blockers.