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 mL/min per 1.73 m(2). 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 m(2) in 50.3% of patients, 45−30 mL/min per 1.73 m(2) in 37.4%, and < 30 mL/min per 1.73 m (2) 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 m (2); HR = 0.47, 95% CI: 0.26−0.86,P < 0.0001), stage IIIb (GFR 30−45 mL/min per 1.73 m (2); HR = 0.55, 95% CI: 0.26−1.06,P = 0.007), and stages IV and V (GFR < 30 mL/min per 1.73 m (2); 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.