Beta-blocker therapy in elderly patients with renal dysfunction and heart failure

OBJECTIVE To assess the role of beta-blockers(BB) in patients with chronic kidney disease(CKD) aged ≥ 75 years.METHODS AND RESULTS From January 2008 to July 2014, we included 390 consecutive patients ≥ 75 years of age with ejection fraction ≤ 35% and glomerular filtration rate(GFR) ≤ 60 m L/min per 1.73 m2. We analyzed the relationship between treatment with BB and mortality or cardiovascular events. The mean age of our population was 82.6 ± 4.1 years. Mean ejection fraction was 27.9% ± 6.5%. GFR was 60-45 m L/min per 1.73 m2 in 50.3% of patients, 45-30 m L/min per 1.73 m2 in 37.4%, and < 30 m L/min per 1.73 m2 in 12.3%. At the conclusion of follow-up, 67.4% of patients were receiving BB. The median follow-up was28.04(IR: 19.41-36.67) months. During the study period, 211 patients(54.1%) died and 257(65.9%) had a major cardiovascular event(death or hospitalization for heart failure). BB use was significantly associated with a reduced risk of death(HR = 0.51, 95%CI: 0.35-0.74; P < 0.001). Patients receiving BB consistently showed a reduced risk of death across the different stages of CKD:stage IIIa(GFR = 30-45 m L/min per 1.73 m2; HR = 0.47, 95% CI: 0.26-0.86, P < 0.000 1), stage IIIb(GFR 30-45 m L/min per 1.73 m2; HR = 0.55, 95% CI: 0.26-1.06, P = 0.007), and stages IV and V(GFR < 30 m L/min per 1.73 m2; HR = 0.29, 95% CI: 0.11-0.76; P =0.047).CONCLUSIONS The use of BB in elderly patients with HFr EF and renal impairment was associated with a better prognosis.Use of BB should be encouraged when possible.