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 - Tập 12 Số 6 - Trang 607-616 - 2010
Davide Castagno1,2, Pardeep S. Jhund1, John J.V. McMurray1, Jim Lewsey3, Erland Erdmann4, Faı̈ez Zannad5, Willem J. Remme6, José López‐Sendón7, Philippe Lechat8, Ferenc Folláth9, Christer Höglund10, Mareev VIu11, Zygmunt Sadowski12, R Seabra-Gomes13, Henry J. Dargie14
1BHF Glasgow Cardiovascular Research Centre, Faculty of Medicine, University of Glasgow, Glasgow G12 8TA, UK
2Cardiology Unit, Department of Internal Medicine, University of Turin, Turin, Italy
3Department of Public Health, Faculty of Medicine, University of Glasgow, Glasgow, UK
4Department III of Internal Medicine, University of Cologne, Cologne, Germany
5Inserm, CIC9501, U961, CHU and University of Nancy, Nancy, France
6Sticares Cardiovascular Research Institute, Rhoon, Netherlands
7Department of Cardiology, University Hospital La Paz, Madrid, Spain
8Pharmacology Department Pitié‐Salpêtrière Hospital, APHP, UPMC Paris
9University Hospital Zürich, Zürich, Switzerland
10City Heart Stockholm Sweden
11Myasnikow Institute of Cardiology, Moscow, Russia
12National Institute of Cardiology, Warsaw, Poland
13Cardiology Department, Santa Cruz Hospital, Carnaxide, Portugal
14Western Infirmary, Glasgow, UK

Tóm tắt

AimsInformation 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.Methods and resultsThe Cockcroft–Gault formula normalized for body surface‐area was used to estimate renal function (eGFRBSA) in 2622 patients with HF, left ventricular ejection fraction ≤35%, New York Heart Association class III/IV and serum creatinine <300 μmol/L (3.4 mg/dL) in the second Cardiac Insufficiency Bisoprolol Study II. Patients were divided into four sub‐groups according to baseline eGFRBSA (<45, 45–60, 60–75 and ≥75 mL/min per 1.73 m2). Cox proportional‐hazards models adjusted for pre‐specified confounders were used to assess the effect of bisoprolol and potential heterogeneity of effect across the eGFRBSA sub‐groups. Older age, female‐sex, diabetes and ischaemic‐aetiology were more common in those with reduced eGFRBSA. 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 eGFRBSA 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 eGFRBSA < 45 mL/min per 1.73 m2. Nevertheless the absolute benefit of bisoprolol was greater for patients with chronic kidney disease compared with those without.ConclusionThe beneficial effects of bisoprolol on mortality and hospitalization for worsening heart‐failure were not modified by baseline eGFRBSA. Renal impairment should not prevent the use of bisoprolol in patients with HF.

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Tài liệu tham khảo

10.1161/01.CIR.102.2.203

10.7326/0003-4819-130-6-199903160-00002

10.5414/CNP66089

Rostoker G, 2007, A modified Cockcroft–Gault formula taking into account the body surface area gives a more accurate estimation of the glomerular filtration rate, J Nephrol, 20, 576

10.1001/archinte.1916.00080130010002

10.1056/NEJM199108013250501

10.1056/NEJM199209033271003

10.1056/NEJM198409273111303

10.1056/NEJM199212313272704

Thông tin
Thông tin xuất bản

European Journal of Heart Failure

Tập 12 Số 6

607-616

Thông tin tác giả