Improved survival with bisoprolol in patients with heart failure and renal impairment: an analysis of the cardiac insufficiency bisoprolol study II (CIBIS-II) trial

Castagno, D. et al. (2010) Improved survival with bisoprolol in patients with heart failure and renal impairment: an analysis of the cardiac insufficiency bisoprolol study II (CIBIS-II) trial. European Journal of Heart Failure, 12(6), pp. 607-616. (doi:10.1093/eurjhf/hfq038)

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Abstract

Information on the effectiveness of beta-blockade in patients with heart failure (HF) and concomitant renal impairment is scarce and beta-blockers are underutilized in these patients. The Cockcroft-Gault formula normalized for body surface-area was used to estimate renal function (eGFR(BSA)) in 2622 patients with HF, left ventricular ejection fraction < 35%, New York Heart Association class III/IV and serum creatinine < 300 mu mol/L (3.4 mg/dL) in the second Cardiac Insufficiency Bisoprolol Study II. Patients were divided into four sub-groups according to baseline eGFR(BSA) (< 45, 45-60, 60-75 and >= 75 mL/min per 1.73 m(2)). Cox proportional-hazards models adjusted for pre-specified confounders were used to assess the effect of bisoprolol and potential heterogeneity of effect across the eGFR(BSA) sub-groups. Older age, female-sex, diabetes and ischaemic-aetiology were more common in those with reduced eGFR(BSA). The hazard associated with bisoprolol use for all-cause mortality, the composite of all-cause mortality or HF-hospitalization and HF-hospitalization alone was consistently < 1.0 across eGFR(BSA) categories with no treatment by renal-function interaction (P = 0.81, P = 0.66, P = 0.71, respectively). The rate of bisoprolol discontinuation was higher in patients with eGFR(BSA) < 45 mL/min per 1.73 m(2). Nevertheless the absolute benefit of bisoprolol was greater for patients with chronic kidney disease compared with those without. The beneficial effects of bisoprolol on mortality and hospitalization for worsening heart-failure were not modified by baseline eGFR(BSA). Renal impairment should not prevent the use of bisoprolol in patients with HF

Item Type:Articles
Keywords:Adrenergic AGE ASSOCIATION BETA beta-Blocker Chronic chronic kidney disease CREATININE CREATININE CLEARANCE diabetes DIALYSIS PATIENTS DISEASE Drugs EJECTION FRACTION ENGLAND FAILURE GLOMERULAR-FILTRATION-RATE HEART Heart failure HEART-FAILURE Impairment Kidney MERIT-HF MODEL MORTALITY MYOCARDIAL-INFARCTION Nervous system NEUROHORMONAL ACTIVATION PATIENT patients PROGNOSTIC VALUE RANDOMIZED INTERVENTION TRIAL Receptors renal function Scotland SERUM SERUM CREATININE SURVIVAL Sympathetic SYSTEM Treatment TRIAL ventricular ejection fraction VENTRICULAR EJECTION FRACTIONS
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Dargie, Professor Henry and Jhund, Dr Pardeep and Lewsey, Professor Jim and McMurray, Professor John
Authors: Castagno, D., Jhund, P.S., McMurray, J.J.V., Lewsey, J.D., Erdmann, E., Zannad, F., Remme, W. J., Lopez-Sendon, J. L., Lechat, P., Follath, F., Hoglund, C., Mareev, V., Sadowski, Z., Seabra-Gomes, R. J., and Dargie, H.J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
Journal Name:European Journal of Heart Failure
ISSN:1388-9842

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