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Sökning: onr:"swepub:oai:gup.ub.gu.se/286734" > Impact of Renal Imp...

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FältnamnIndikatorerMetadata
00004578naa a2200529 4500
001oai:gup.ub.gu.se/286734
003SwePub
008240528s2019 | |||||||||||000 ||eng|
0247 a https://gup.ub.gu.se/publication/2867342 URI
0247 a https://doi.org/10.1016/j.jacc.2019.09.0592 DOI
040 a (SwePub)gu
041 a eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Kotecha, Dipak4 aut
2451 0a Impact of Renal Impairment on Beta-Blocker Efficacy in PatientsWithHeartFailure.
264 1b Elsevier BV,c 2019
520 a 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.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kardiologi0 (SwePub)302062 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Cardiac and Cardiovascular Systems0 (SwePub)302062 hsv//eng
7001 a Gill, Simrat K4 aut
7001 a Flather, Marcus D4 aut
7001 a Holmes, Jane4 aut
7001 a Packer, Milton4 aut
7001 a Rosano, Giuseppe4 aut
7001 a Böhm, Michael4 aut
7001 a MacMurray, John J V4 aut
7001 a Wikstrand, John,d 1938u Gothenburg University,Göteborgs universitet,Wallenberglaboratoriet,Wallenberg Laboratory4 aut0 (Swepub:gu)xwikjo
7001 a Anker, Stefan D4 aut
7001 a van Veldhuisen, Dirk J4 aut
7001 a Manzano, Luis4 aut
7001 a von Lueder, Thomas G4 aut
7001 a Ridby, Alan S4 aut
7001 a Andersson, Bert,d 1952u Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine4 aut0 (Swepub:gu)xanber
7001 a Kjekshus, John4 aut
7001 a Wedel, Hansu Gothenburg 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 Metrics4 aut0 (Swepub:gu)xwedha
7001 a Ruschitzka, Frank4 aut
7001 a Cleland, John G F4 aut
7001 a Damman, Kevin4 aut
7001 a Redon, Josep4 aut
7001 a Coats, Andrew J S4 aut
7102 a Göteborgs universitetb Wallenberglaboratoriet4 org
7730 t Journal of the American College of Cardiologyd : Elsevier BVg 74:23, s. 2893-2904q 74:23<2893-2904x 1558-3597x 0735-1097
8564 u https://doi.org/10.1016/j.jacc.2019.09.059
8564 8u https://gup.ub.gu.se/publication/286734
8564 8u https://doi.org/10.1016/j.jacc.2019.09.059

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