β-blockers in elderly patients with CHF and CKD: What is the impact on mortality?

1. In this article, we present to you data from a large retrospective cohort study that investigated the impact on mortality with β-blockers use versus non-use in elderly patients with CHF and CKD.

Introduction

Beta-blockers (β-blockers) are highly effective in reducing mortality in patients with congestive heart failure (CHF). About 20%-74% of CHF patients are known to have concomitant chronic kidney disease (CKD); advanced CKD [estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2] is associated with significant increase in all-cause mortality. However, there are limited studies evaluating the effect of β-blockers on mortality in CHF patients with CKD. A large retrospective cohort study examined the association of β-blocker use versus non-use with mortality among incident elderly patients (median age: 79 years) with CHF and various stages of CKD using administrative health care databases.

Results

β-blocker use was associated with reduced all-cause mortality.
A consistent reduction in mortality was noted across eGFR categories (eGFR >60: adjusted HR: 0.55, eGFR: 30–60: adjusted HR: 0.63, eGFR <30: adjusted HR: 0.55, interaction term, P = 0.30).

However, eGFR <30 group had the highest overall mortality reduction indicating that advanced CKD stages are associated with a greater absolute mortality reduction.

β-blocker use showed consistent results in both the intention-to-treat and time-varying analyses.
β-blockade is beneficial in CHF patients with CKD, as both these conditions are associated with sympathetic upregulation which is linked to poor outcomes.
Bisoprolol, metoprolol succinate and carvedilol (evidence-based β-blockers) showed a slightly greater mortality benefit (P = 0.008) compared to metoprolol tartrate, atenolol and others (non-evidence based β-blockers).

Conclusion

β-blocker use is associated with reduced all-cause mortality in elderly patients with CHF and CKD, including those with an eGFR <30 mL/min/1.73 m2.
Evidence based β-blockers like bisoprolol, metoprolol succinate and carvedilol had a higher mortality benefit compared to non-evidence based β-blockers.

References