Cardiovascular disease continues to be a major health concern and leads to significant perioperative morbidity and mortality. Evidence for prophylactic use of beta-blockade to decrease these complications continues to grow. Not all patients benefit from perioperative beta-blockade, thus a thorough preoperative cardiac assessment should be performed with every patient undergoing surgery. Although physicians may have doubts with this new strategy, the literature overwhelmingly supports prophylactic beta-blockade use as a safe, efficacious, and cost effective new therapy in patients at risk for cardiac complications.