Perioperative blockade: guidelines do not reflect the problems with the evidence from the DECREASE trials

The trials underpinning initiation of perioperative β blockers in patients with ischaemic heart disease having high risk surgery have largely been discredited, and the remaining evidence points to an increased risk of death. However, changes to the European guidelines have been slow. Graham Cole and Darrel Francis call for improvements to permit guideline experts to perform rapid amendments when required