Impact of renal impairment on beta-blocker efficacy in patients with heart failure

Research output: Contribution to journalArticle

Standard

Impact of renal impairment on beta-blocker efficacy in patients with heart failure. / Beta-Blockers in Heart Failure Collaborative Group ; Kotecha, Dipak; Gill, Simrat.

In: Journal of the American College of Cardiology, Vol. 74, No. 23, 10.12.2019, p. 2893-2904.

Research output: Contribution to journalArticle

Harvard

APA

Vancouver

Author

Beta-Blockers in Heart Failure Collaborative Group ; Kotecha, Dipak ; Gill, Simrat. / Impact of renal impairment on beta-blocker efficacy in patients with heart failure. In: Journal of the American College of Cardiology. 2019 ; Vol. 74, No. 23. pp. 2893-2904.

Bibtex

@article{cccdd52b595e43cf9d486f3b13dc9c2d,
title = "Impact of renal impairment on beta-blocker efficacy in patients with heart failure",
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 = "renal impairment, heart failure, beta-blockers, mortality",
author = "{Beta-Blockers in Heart Failure Collaborative Group} and Dipak Kotecha and Simrat Gill and Flather, {Marcus D} and Jane Holmes and Milton Packer and Giuseppe Rosano and Michael B{\"o}hm and McMurray, {John J.V.} and John Wikstrand and Stefan Anker and Veldhuisen, {Dirk J van} and Luis Manzano and Lueder, {Thomas G von} and Rigby, {Alan S} and Bert Andersson and John Kjekshus and Hans Wedel and Frank Ruschitzka and Cleland, {John G} and Kevin Damman and Josep Redon and Coats, {Andrew J}",
year = "2019",
month = dec
day = "10",
doi = "10.1016/j.jacc.2019.09.059",
language = "English",
volume = "74",
pages = "2893--2904",
journal = "Journal of American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier",
number = "23",

}

RIS

TY - JOUR

T1 - Impact of renal impairment on beta-blocker efficacy in patients with heart failure

AU - Beta-Blockers in Heart Failure Collaborative Group

AU - Kotecha, Dipak

AU - Gill, Simrat

AU - Flather, Marcus D

AU - Holmes, Jane

AU - Packer, Milton

AU - Rosano, Giuseppe

AU - Böhm, Michael

AU - McMurray, John J.V.

AU - Wikstrand, John

AU - Anker, Stefan

AU - Veldhuisen, Dirk J van

AU - Manzano, Luis

AU - Lueder, Thomas G von

AU - Rigby, Alan S

AU - Andersson , Bert

AU - Kjekshus, John

AU - Wedel, Hans

AU - Ruschitzka, Frank

AU - Cleland, John G

AU - Damman, Kevin

AU - Redon, Josep

AU - Coats, Andrew J

PY - 2019/12/10

Y1 - 2019/12/10

N2 - 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.

AB - 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.

KW - renal impairment

KW - heart failure

KW - beta-blockers

KW - mortality

U2 - 10.1016/j.jacc.2019.09.059

DO - 10.1016/j.jacc.2019.09.059

M3 - Article

C2 - 31806133

VL - 74

SP - 2893

EP - 2904

JO - Journal of American College of Cardiology

JF - Journal of American College of Cardiology

SN - 0735-1097

IS - 23

ER -