Beta-blockers are an effective method to prevent mortality in patients with heart failure characterised by reduced ejection fraction (HFrEF) and sinus rhythm; this also applies to those individuals with moderate (eGFR 45-59 mL/min/1.73m2) or moderate-severe renal dysfunction (30-44 mL/min/1.73m2).
Renal insufficiency is a common feature in HF patients. The lack of evidence-based therapies in this population can be a real challenge. Kotecha and colleagues conducted an analysis using data from HFrEF patients (n=16,740) derived from 10 landmark, double-blind, placebo-controlled randomised trials to assess the role of beta-blockers in HF patients with renal impairment. Primary endpoint was all-cause mortality. Median age of the patients was 65 years; 23% were female and the median follow-up was 1.3 years. In general, it can be stated that renal dysfunction was independently associated with higher mortality. The cause of death was more often due to progressive HF in patients with more severe renal impairment. Beta-blockers significantly reduced mortality; for patients with moderate kidney dysfunction, there was a 27% lower risk of death when compared to placebo. For those with moderate-severe kidney dysfunction, the risk was 29% lower. In this last population, the absolute risk reduction from beta-blockers for all-cause mortality is 4.7%. Importantly, in patients with renal impairment, beta-blockers did not negatively impact eGFR. Also, no increase in adverse events (AEs) was observed in comparison with placebo. Thus, HFrEF patients in sinus rhythm with moderate or moderately-severe renal dysfunction should not be restricted from receiving beta-blockers as long as they receive the correct dose. However, this recommendation excludes patients with severe end-stage kidney disease (eGFR <30 mL/min/1.73m2); these patients have not been assessed and therefore, no recommendations or statements can be made .
1. Kotecha D. BB-meta-HF – Beta-blockers are effective in high-risk heart failure patients with reduced ejection fraction and moderately-severe renal dysfunction. FP Number 4194. ESC Congress 2019, 31 Aug-4 Sept, Paris, France.
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