Beta-blockers beneficial in heart failure patients with renal dysfunction
The use of beta-blockers is beneficial in patients with heart failure, reduced ejection fraction (HFrEF), and kidney dysfunction.
Delhi: The findings, published in the Journal of the American College of Cardiology recommends that 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.
Heart failure is associated with numerous comorbidities including renal impairment which is of particular importance due to its impact on mortality as well as on the use of guideline-recommended therapies. Impaired renal function is independently associated with worse outcomes; in meta-analyses of 57 studies including trials and cohorts in HF, there was a 2-fold increase in the odds of death comparing patients with and without renal dysfunction. Whether beta-blockers are effective is unclear, leading to the underuse of life-saving therapy.
The study by Dipak Kotecha, University of Birmingham, Birmingham, United Kingdom, sought to investigate patient prognosis and the efficacy of beta-blockers according to renal function using the estimated glomerular filtration rate (eGFR).
The study involved an analysis of 16,740 individual patients with left ventricular ejection fraction <50% from 10 double-blind, placebo-controlled trials. The current analysis focused on all-cause mortality on an intention-to-treat basis. Baseline covariates were adjusted for and results were stratified by heart rhythm. Median follow-up was 1.3 years.
Median eGFR at baseline was 63 mL/min/1.73 m2 (interquartile range: 50 to 77), with 4,584 patients (27.4%) having eGFR from 45 to 59 mL/min/1.73 m2, and 2,286 individuals(13.7%) having eGFR between 30 and 44 mL/min/1.73 m2.
Key findings of the study include:
- 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.
- 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 and 0.71 for eGFR 30 to 44 ml/min/1.73 m2
- 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 conclude.
- In 2,879 patients with atrial fibrillation, there was no reduction in mortality with beta-blockers at any level of eGFR.
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"The study confirmed the efficacy of beta-blockers in heart failure patients with reduced ejection fraction, sinus rhythm and renal dysfunction, including those with eGFR 30 to 44 ml/min/1.73 m2, the lowest range of eGFR tested in large placebo-controlled trials," wrote the authors.
The study, "Impact of Renal Impairment on Beta-Blocker Efficacy in Patients With Heart Failure," is published in the Journal of the American College of Cardiology.