Beta blocker usage in cardiac CT: A survey of BCSI members

To examine the current practice of British Society of Cardiovascular Imaging (BSCI) members in the administration of beta blockers in computed tomography (CT) coronary angiography (CTCA) a 10-point online questionnaire was emailed to all registered members of the British Society of Cardiovascular Imaging. There were 61 respondents: 75% give intravenous (IV) metoprolol in the CT department, the rest a combination of oral and/or IV dosing. Over 50% were happy to administer 50 mg or more. No serious complications related to drug administration had been seen by 82%. Of the remaining 18%, half (six reports) documented severe hypotension and two reported a death. No physical observations were taken by 25%, at any point. Another 27% checked blood pressure before the scan only, 17% measured blood pressure before the scan and immediately after and 28% measured before the scan and after with a delay. In conclusion, among BSCI members, there is no uniform strategy regarding the route or dose of beta blocker administration, or if, when and what physical observations should be performed. Several severe adverse events have been documented, including two deaths. This, however, is in the context of the large volume of CTCAs performed nationally, and so, despite some doses of beta blocker exceeding British National Formulary recommendations, this appears safe.