Beta-blocker use benefits patients with HFrEF and chronic kidney disease

Beta-blockers can improve survival among patients with heart failure with reduced ejection fraction (HFrEF) and advanced chronic kidney disease (CKD), according to findings published in Circulation: Heart Failure. These same benefits were not seen in patients with heart failure with midrange ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF) and CKD.

“Although persons with advanced CKD typically represent 10% to 15% of the heart failure (HF) population, they have been systematically excluded or underrepresented in HF clinical trials, leading to uncertainty about the effect of therapies and optimal management for them,” wrote first author Edouard L. Fu, BSc, department of clinical epidemiology at Leiden University Medical Center in the Netherlands, and colleagues.

Fu’s team explored data from the Swedish Heart Failure Registry, including more than 76,000 patients treated for HF from May 11, 2000, and Dec. 31, 2016. More than 7,000 of those patients had advanced CKD. Based on left ventricular ejection fraction evaluations, more than 3,500 patients had HFrEF, more than 2,000 had HFpEF and more than 1,500 had HFmrEF. The median follow-up period was 1.3 years.

Overall, in patients with HFrEF and CKD, beta-blocker use was associated with a lower risk of mortality and a lower risk of the composite outcome of cardiovascular death and hospitalization for heart failure. These trends did not carry over, however, to patients with HFmrEF or HFpEF and CKD. It is possible, though, that this is because the number of patients in the study with HFmrEF or HFpEF was much smaller than the number of patients with HFrEF. Randomized trials will be necessary, the team added, to confirm these findings.

“Our analyses support current guideline recommendations on beta-blocker therapy in HFrEF patients regardless of kidney function,” the team concluded.

Click here to read the full analysis in Circulation: Heart Failure.