Perioperative b-Blockers in Patients Undergoing Noncardiac Surgery-Scientific Misconduct and Clinical Guidelines Dhauna Karam, MD* and Rohit Arora, MD Background: b-blocker use in perioperative period of noncardiac surgeries has been a topic of debate since many years. Earlier studies conducted in the 90s showed decreased cardiac adverse events and improved postoperative outcomes with b-blocker use. Based on this, the ACCF and ESC published guidelines strongly supporting b-blocker use. But contemporaneous studies conducted revealed conflicting evidence and have also proven some of the earlier studies to be fraudulent. Although ACCF guidelines have been updated to partially reflect the changes, ESC guidelines continue to support b-blocker use. Areas of Uncertainty: In light of the ACCF and ESC guidelines supporting b-blocker use in peri- operative period of noncardiac surgeries, our aim was to review the available literature and consol- idate evidence in this regard. Data Sources: PubMed search was conducted to include relevant studies between 1950 and 2015. Results: We reviewed 24 eligible studies and few debates conducted in this regard. Based on our review, our findings were as follows: b-blockers should be continued throughout perioperative period in patients who were on b-blockers before surgery for other indications such as angina, hypertension, and symptomatic arrhythmias. Preoperative b-blockers are indicated in patients undergoing high risk vascular surgery or those having high preoperative Cardiac Risk Index Score. In patients with intermediate-to-low cardiac risk, the proven benefit is not sufficient enough to suggest universal use. Conclusions: Based on our review, we conclude that the use of b-blockers in perioperative period of noncardiac surgeries should be determined on an individual basis based on risk–benefit analysis. Guideline organizations should update their recommendations based on new evidence. Keywords: b-blockers, use, non-cardiac surgery, mortality BACKGROUND There are millions of people worldwide who undergo elective and emergency noncardiac surgeries every day. The healthy aging population because of advanced treatment of chronic conditions has in turn increased the incidence of noncardiac surgeries in the elderly population. In such patients, cardiac complications are one of the most common causes of morbidity and mortality. Among the various cardiac complica- tions, heart failure tops the list. It is estimated that heart failure is present in approximately 20% of elderly undergoing noncardiac surgery. Heart failure increases risk of adverse cardiac events and death in perioperative period. Perioperative b-blocker use was initially considered a simple yet promising strategy to prevent adverse cardiac outcomes but over years there were multiple studies performed which proved the contrary. The objective of our review article was Department of Medicine, Chicago Medical School, North Chicago, IL. The authors have no conflicts of interest to declare. *Address for correspondence: Department of Internal Medicine, Capt James A lovell federal health care centre, Chicago Medical school/RFUMS, 3001 Green Bay Road, North Chicago, IL 60064. E-mail: dhauna.karam@va.gov American Journal of Therapeutics 0, 1–7 (2017) 1075–2765 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. www.americantherapeutics.com Copyright Ó 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.