Effectiveness of β-Blockers in Heart Failure With Left Ventricular Systolic Dysfunction and Chronic Kidney Disease

JOURNAL OF CARDIAC FAILURE

卷:19

Article

Chang, Tara I.¹  Yang, Jingrong²  Freeman, James V.¹  Hlatky, Mark A.¹  Go, Alan S.^1,2,3,4,5 

[1] Stanford Univ, Sch Med, Stanford, CA 94305 USA

[2] Kaiser Permanente Northern Calif, Div Res, Oakland, CA 94612 USA

[3] Univ Calif San Francisco, Dept Epidemiol, San Francisco, CA 94143 USA

[4] Univ Calif San Francisco, Dept Biostat, San Francisco, CA 94143 USA

[5] Univ Calif San Francisco, Dept Med, San Francisco, CA 94143 USA

关键词: Heart failure;    renal dysfunction;    chronic kidney disease;    beta-blockers;    death;    hospitalizations;    cardiovascular disease;    epidemiology;   

DOI  :  10.1016/j.cardfail.2013.01.006

来源: Elsevier

【 摘 要 】

Background: Establishing medication effectiveness outside of a randomized trial requires careful study design to mitigate selection bias. Previous observational studies of beta-blockers in patients with chronic kidney disease and heart failure have had methodologic limitations that may have introduced bias. We examined whether initiation of beta-blocker therapy was associated with better outcomes among patients with chronic kidney disease and newly diagnosed heart failure with left ventricular systolic dysfunction. Methods and Results: We identified 668 adults in the Kaiser Permanente Northern California system from 2006 to 2008 with chronic kidney disease, incident heart failure, left ventricular systolic dysfunction, and no previous beta-blocker use. We defined chronic kidney disease as estimated glomerular filtration rate <60 mL min(-1) 1.73 m(-2) or proteinuria, and we excluded patients receiving dialysis. We used extended Cox regression to assess the association of treatment with death and the combined end point of death or heart failure hospitalization. Initiation of beta-blocker therapy was associated with a significantly lower crude risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.35-0.63), but this association was attenuated and no longer significant after multivariable adjustment (HR 0.75, CI 0.51-1.12). beta-Blocker therapy was significantly associated with a lower risk of death or heart failure hospitalization even after adjustment for potential confounders (HR 0.67, CI 0.51-0.88). Conclusions: beta-Blocker therapy is associated with lower risk of death or heart failure hospitalization among patients with chronic kidney disease, incident heart failure, and left ventricular systolic dysfunction. (J Cardiac Fail 2013;19:176-182)

【 授权许可】

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