Impact of Renal Impairment on Beta-Blocker Efficacy in Patients With Heart Failure - PubMed (original) (raw)
Randomized Controlled Trial
. 2019 Dec 10;74(23):2893-2904.
doi: 10.1016/j.jacc.2019.09.059.
Simrat K Gill 2, Marcus D Flather 3, Jane Holmes 4, Milton Packer 5, Giuseppe Rosano 6, Michael Böhm 7, John J V McMurray 8, John Wikstrand 9, Stefan D Anker 10, Dirk J van Veldhuisen 11, Luis Manzano 12, Thomas G von Lueder 13, Alan S Rigby 14, Bert Andersson 15, John Kjekshus 16, Hans Wedel 17, Frank Ruschitzka 18, John G F Cleland 19, Kevin Damman 11, Josep Redon 20, Andrew J S Coats 6; Beta-Blockers in Heart Failure Collaborative Group
Affiliations
- PMID: 31806133
- DOI: 10.1016/j.jacc.2019.09.059
Free article
Randomized Controlled Trial
Impact of Renal Impairment on Beta-Blocker Efficacy in Patients With Heart Failure
Dipak Kotecha et al. J Am Coll Cardiol. 2019.
Free article
Erratum in
- Correction.
[No authors listed] [No authors listed] J Am Coll Cardiol. 2020 Apr 7;75(13):1615. doi: 10.1016/j.jacc.2020.02.037. J Am Coll Cardiol. 2020. PMID: 32241383 No abstract available.
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.
Keywords: beta-blockers; heart failure; mortality; renal impairment.
Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.
Comment in
- Heart Failure With Reduced Ejection Fraction and Renal Dysfunction: Beta-Blockers Do Not Disappoint.
Deswal A. Deswal A. J Am Coll Cardiol. 2019 Dec 10;74(23):2905-2907. doi: 10.1016/j.jacc.2019.10.012. J Am Coll Cardiol. 2019. PMID: 31806134 No abstract available. - Pooled RCTs: In patients with HF in sinus rhythm, β-blockers reduced mortality at GFR ≥ 30 mL/min/1.73 m2.
Deif B, Van Spall HGC. Deif B, et al. Ann Intern Med. 2020 Apr 21;172(8):JC38. doi: 10.7326/ACPJ202004210-038. Ann Intern Med. 2020. PMID: 32311722 No abstract available.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Research Materials
Miscellaneous