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
Yearly Monitoring
-Asymptomatic
-Continue BP Control w ACEi
-Continue yearly screening with U/S
Thoracic Aortic Aneurysms
52mm
49mm
2010
2016
-AAA 3.0-5.0cm
BP Control (ACEi)
Randomized
Con't Propranolol
+
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
-Unlikely to rupture at this diameter
Double-Blind
My Patient
Both groups had U/S every 6mos to monitor aneurysm growth
Epidemiology of Aortic Aneurysms
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)
BP <140/90
Danyi, P. et al. Medical Therapy of Thoracic Aortic Aneurysms. Circulation. 2011. 124: 1469-1476
Last HbA1C 6.4%
LDL on target
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