Beta-Blockers Recommended in HF Patients with Renal Dysfunction

The use of beta-blockers in patients with heart failure, reduced ejection fraction, and renal dysfunction may be beneficial, according to new research published in the Journal of the American College of Cardiology.

“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 under-use of life-saving therapy,” study researchers for the Beta-Blockers in Heart Failure Collaborative Group explained. “This study sought to investigate the patient prognosis and efficacy of beta-blockers according to renal function using estimated glomerular filtration rate (eGFR).”

The analysis included 16,740 individuals from 10 different double-blind, placebo-controlled studies, who all had left ventricular ejection fraction <50%. 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.

According to the results, eGFR was independently linked with mortality, a 12% increased risk for death for every 10 mL/min/1.73m2 reduction in eGFR (95% CI, 10% to 15%; P<0.001). Beta-blockers were associated with reduced mortality versus placebo in 13,861 patients in sinus rhythm (adjusted HR=0.73 for eGFR range 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). No deterioration in renal function over time was reported in those patients with moderate or moderately severe renal impairment. There were also no reported differences in adverse events between those receiving beta-blockers and those taking placebo.

“Combining double-blind, individual patient-level data has provided a sufficient sample size to confirm 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,” the researchers wrote in their conclusion.