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Impact of Renal Imp...
Impact of Renal Impairment on Beta-Blocker Efficacy in PatientsWithHeartFailure.
- Article/chapterEnglish2019
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LIBRIS-ID:oai:gup.ub.gu.se/286734
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https://gup.ub.gu.se/publication/286734URI
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https://doi.org/10.1016/j.jacc.2019.09.059DOI
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Subject category:art swepub-publicationtype
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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.This study sought to investigate patient prognosis and the efficacy of beta-blockers according to renal function using estimated glomerular filtration rate (eGFR).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.Median eGFR at baseline was 63 (interquartile range: 50 to 77) ml/min/1.73m2; 4,584 patients (27.4%) had eGFR 45 to 59ml/min/1.73m2, and 2,286 (13.7%) 30 to 44ml/min/1.73m2. Over a median follow-up of 1.3 years, eGFR was independently associated with mortality, with a 12% higher risk of death for every 10ml/min/1.73m2 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 59ml/min/1.73m2 (95%CI: 0.62 to 0.86; p<0.001) and 0.71 for eGFR 30 to 44ml/min/1.73m2 (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 functionon follow-up. Due to exclusion criteria, there were insufficient patients with severe renal dysfunction (eGFR<30ml/min/1.73m2) to draw conclusions. In 2,879 patients with atrial fibrillation, there was no reduction in mortality with beta-blockers at any level of eGFR.Patients with heart failure, left ventricular ejection fraction<50% and sinus rhythm should receivebeta-blocker therapy even with moderate or moderately severe renal dysfunction.
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Gill, Simrat K
(author)
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Flather, Marcus D
(author)
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Holmes, Jane
(author)
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Packer, Milton
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Rosano, Giuseppe
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Böhm, Michael
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MacMurray, John J V
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Wikstrand, John,1938Gothenburg University,Göteborgs universitet,Wallenberglaboratoriet,Wallenberg Laboratory(Swepub:gu)xwikjo
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Anker, Stefan D
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van Veldhuisen, Dirk J
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Manzano, Luis
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von Lueder, Thomas G
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Ridby, Alan S
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Andersson, Bert,1952Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine(Swepub:gu)xanber
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Kjekshus, John
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Wedel, HansGothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, enheten för hälsometri,Institute of Medicine, Department of Public Health and Community Medicine, Health Metrics(Swepub:gu)xwedha
(author)
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Ruschitzka, Frank
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Cleland, John G F
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Damman, Kevin
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Redon, Josep
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Coats, Andrew J S
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Göteborgs universitetWallenberglaboratoriet
(creator_code:org_t)
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In:Journal of the American College of Cardiology: Elsevier BV74:23, s. 2893-29041558-35970735-1097
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