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Search Strategy (PUBMED)

Research Question

(Propranolol OR Beta Blocker) AND TAA

"In patients with Thoracic Aortic Aneurysms of <5.0cm in size, does the use of beta blockers reduce the rate of growth of the aneurysm diameter better than placebo?"

9 Results None Applicable

TO THE RESEARCH!

(Propranolol OR Beta Blocker) AND Aortic Aneurysm

P- Patients with thoracic aortic aneurysms of <5.0cm in size

I- Use of Beta Blockers

C- Placebo

O- Reduction of the growth of the diameter of the TAA over time

333 Results

(Propranolol OR Beta Blocker) AND Aortic Aneurysm AND Small

25 Results 6 Applicable 1 Chosen

Use of Beta-Blockers in Thoracic Aortic Aneurysms

Application to the Patient

Natural History

The Study

Mitchell Baruta

10074663

U of C MD Program, Class of 2017

Family Medicine Block

Stop Propranolol

+

My Patient

n=548

Multi-Centre

~0-1cm/yr

Yearly Monitoring

-Asymptomatic

-Continue BP Control w ACEi

-Continue yearly screening with U/S

Thoracic Aortic Aneurysms

52mm

49mm

Minimal Risk

2010

2016

-AAA 3.0-5.0cm

<4.0cm

4.0-6.0cm

6.0cm+

15% /5yrs

BP Control (ACEi)

BP

Randomized

Con't Propranolol

+

30% /5yrs

n=272

n=276

Propranolol 60mg

Kälsch H, Lehmann N, Möhlenkamp S, et al.

Int J Cardiol 2013; 163:72.

Crawford ES, Cohen ES. Aortic aneurysm: multifocal disease. Presidential address. Arch Surg 1982; 117:1393.

Yearly Monitoring (Echo)

Propranolol

Placebo

Placebo-Controlled

Elective Surgery

-Surgery Risks and Recovery Time

Both groups similar in terms of sex, race, age, comorbidities

Commonly Accepted Treatments

Large

>5.0cm / 0.5cm+/yr

Small <5.0cm

-Unlikely to rupture at this diameter

Double-Blind

My Patient

BP Control

Elective Surgery

Both groups had U/S every 6mos to monitor aneurysm growth

Beta-Blockers

Epidemiology of Aortic Aneurysms

U/S Surveillance

J Vasc Surg. 1994 Aug; 20(2):178-83

Propranolol for small abdominal aortic aneurysms: Results of a Randomized Trial. J Vasc Surg. 2002; 35(1):72-79

Clouse WD, Hallett JW Jr, Schaff HV, et al. Improved prognosis of thoracic aortic aneurysms: a population-based study. JAMA 1998; 280:1926.

-53yo M

-Post-Secondary Instructor

Patients followed for a mean of 2.5 years, up to a max. of 4.5 years

Prevalence- 0.5%

(all types of AA)

Follow-up completed on all but 6 patients

13th Leading Cause of Death

(Western Countries)

ACEi

HTN

BP <140/90

DM2

Diet-Controlled

Danyi, P. et al. Medical Therapy of Thoracic Aortic Aneurysms. Circulation. 2011. 124: 1469-1476

Last HbA1C 6.4%

Lipids

Statin

LDL on target

Obesity

Exercise/Diet

Lost several Kg since Jan.

Take-Home Message

Study Outcomes

Propranolol

Placebo

In patients with small AAA's (3.0-5.0cm), Propranolol does not appear to significantly reduce the rate of aneurysm growth, and may instead result in a lower quality of life.

2.2mm/yr

2.6mm/yr

p=0.11

Rate of Change of AAA Diameter

26.8%

42.4%

p=0.0002

Pts Stopping Med due to SFX

p=0.006

74.4

68.9

Quality of Life Score (Functioning)

This message can likely also be applied to patients with TAA's, as the two pathologies are very similar and similar research on TAA's is not currently available.

57.6

64.0

p=0.002

Quality of Life Score (Vitality)

Discussion and Appraisal

p=0.11

Pts Requiring Surgery

26.5%

20.3%

p=0.36

Mortality

AAAs instead of TAAs, Reduced Applicability

12%

9%

RCT Design- Minimized Bias Risk, Controls Confounders

Sample Size Relatively Large

Study Span may not have been Long Enough

Study Performed Recently

Propranolol only drug studied

Study Results Similar to other Related Studies

Similar Population to my Patient studied, with similar inclusion criteria

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