Beta-blockers are still effective in preventing death in heart failure with reduced ejection fraction (HFrEF) and sinus rhythm, even in patients with moderate or moderately-severe kidney dysfunction, based on findings from the BB-Meta-HF study presented Sept. 2 at ESC Congress 2019.

Researchers analyzed data from 16,740 patients with HFrEF from 10 randomized trials to determine whether beta-blockers reduced mortality in patients with moderate or moderately-severe kidney dysfunction and whether therapy led to reduction in renal function over time or higher rates of adverse events that could limit clinical value. The median age of patients was 65 years and 23 percent were women. Median follow-up was 1.3 years.

Overall results found renal dysfunction was independently associated with higher mortality, and cause of death was more often due to progressive heart failure in patients with more severe renal impairment. In 13,861 patients in sinus rhythm, beta-blockers significantly reduced mortality, even in those with moderate or moderately-severe kidney dysfunction.

After adjustment, beta-blockers were associated with a 27 percent and 29 percent lower risk of death, respectively, compared with placebo. According to researchers, the absolute risk reduction from beta-blockers for all-cause mortality was 4.7 percent in patients with an estimated glomerular filtration rate (eGFR) 30-44 mL/min/1.73m2, the lowest range tested in large placebo-controlled trials, with only 21 patients requiring treatment for a year to save a life. They also noted that in patients with renal impairment, beta-blockers did not lead to any deterioration in eGFR and there was no increase in adverse events compared with placebo.

In other findings, of the 2,879 patients with atrial fibrillation (AFib) at baseline, researchers saw no significant reduction in mortality associated with beta-blockers in any category of eGFR, but also no harm identified. Additionally, worsening renal function of 20 percent or greater during follow-up was also associated with a 28 percent increase in subsequent death overall, and a 46 percent increase in patients with moderate or moderately-severe renal impairment.

"In our study, worsening renal function did not appear to be caused by beta-blocker therapy and all patients were already on ACE inhibitors. Nonetheless, worsening renal function was linked to poor outcomes and this highlights the importance of preserving kidney function by working with renal specialists," said Principal Investigator Dipak Kotecha, MD.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: ESC 19, ESC Congress, Stroke Volume, Heart Failure, Ventricular Dysfunction, Left

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