Impact of Renal Impairment on Beta-Blocker Efficacy in Patients With Heart Failure.
J Am Coll Cardiol
; 74(23): 2893-2904, 2019 12 10.
Article
en En
| MEDLINE
| ID: mdl-31806133
ABSTRACT
BACKGROUND:
Moderate and moderately severe renal impairment are common in patients with heart failure and reduced ejection fraction, but whether beta-blockers are effective is unclear, leading to underuse of life-saving therapy.OBJECTIVES:
This study sought to investigate patient prognosis and the efficacy of beta-blockers according to renal function using estimated glomerular filtration rate (eGFR).METHODS:
Analysis of 16,740 individual patients with left ventricular ejection fraction <50% from 10 double-blind, placebo-controlled trials was performed. The authors report all-cause mortality on an intention-to-treat basis, adjusted for baseline covariates and stratified by heart rhythm.RESULTS:
Median eGFR at baseline was 63 (interquartile range 50 to 77) ml/min/1.73 m2; 4,584 patients (27.4%) had eGFR 45 to 59 ml/min/1.73 m2, and 2,286 (13.7%) 30 to 44 ml/min/1.73 m2. Over a median follow-up of 1.3 years, eGFR was independently associated with mortality, with a 12% higher risk of death for every 10 ml/min/1.73 m2 lower eGFR (95% confidence interval [CI] 10% to 15%; p < 0.001). In 13,861 patients in sinus rhythm, beta-blockers reduced mortality versus placebo; adjusted hazard ratio (HR) 0.73 for eGFR 45 to 59 ml/min/1.73 m2 (95% CI 0.62 to 0.86; p < 0.001) and 0.71 for eGFR 30 to 44 ml/min/1.73 m2 (95% CI 0.58 to 0.87; p = 0.001). The authors observed no deterioration in renal function over time in patients with moderate or moderately severe renal impairment, no difference in adverse events comparing beta-blockers with placebo, and higher mortality in patients with worsening renal function on follow-up. Due to exclusion criteria, there were insufficient patients with severe renal dysfunction (eGFR <30 ml/min/1.73 m2) to draw conclusions. In 2,879 patients with atrial fibrillation, there was no reduction in mortality with beta-blockers at any level of eGFR.CONCLUSIONS:
Patients with heart failure, left ventricular ejection fraction <50% and sinus rhythm should receive beta-blocker therapy even with moderate or moderately severe renal dysfunction.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Volumen Sistólico
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Función Ventricular Izquierda
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Antagonistas Adrenérgicos beta
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Insuficiencia Renal
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Tasa de Filtración Glomerular
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Insuficiencia Cardíaca
Tipo de estudio:
Clinical_trials
/
Prognostic_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Am Coll Cardiol
Año:
2019
Tipo del documento:
Article