ISSN 1671-5411 CN 11-5329/R
Volume 18 Issue 1
Feb.  2021
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Please cite this article as: Martínez-Milla J, García MC, Palfy JA, Urquía MT, Castillo ML, Arbiol AD, Monteagudo ALR, Mariscal MLM, Jiménez-Varas I, Figuero SB, Franco-Pelaéz JA, Tuñón J. Beta-blocker therapy in elderly patients with renal dysfunction and heart failure. J Geriatr Cardiol 2021; 18(1): 20−29. DOI: 10.11909/j.issn.1671-5411.2021.01.005
Citation: Please cite this article as: Martínez-Milla J, García MC, Palfy JA, Urquía MT, Castillo ML, Arbiol AD, Monteagudo ALR, Mariscal MLM, Jiménez-Varas I, Figuero SB, Franco-Pelaéz JA, Tuñón J. Beta-blocker therapy in elderly patients with renal dysfunction and heart failure. J Geriatr Cardiol 2021; 18(1): 20−29. DOI: 10.11909/j.issn.1671-5411.2021.01.005

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

doi: 10.11909/j.issn.1671-5411.2021.01.005
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  •  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 mL/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 mL/min per 1.73 m2 in 50.3% of patients, 45−30 mL/min per 1.73 m2 in 37.4%, and < 30 mL/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 was 28.04 (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 mL/min per 1.73 m2; HR = 0.47, 95% CI: 0.26−0.86, P < 0.0001), stage IIIb (GFR 30−45 mL/min per 1.73 m2; HR = 0.55, 95% CI: 0.26−1.06, P = 0.007), and stages IV and V (GFR < 30 mL/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 HFrEF and renal impairment was associated with a better prognosis. Use of BB should be encouraged when possible.
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