Abstract: FR-OR012

The Association of Beta-Blockers and All-Cause Mortality by eGFR in Patients with Heart Failure

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Molnar, Amber O., McMaster University, Hamilton, Ontario, Canada
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
  • Sood, Manish M., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Background

Congestive heart failure (CHF) and CKD are strongly interrelated and when occurring concurrently, are associated with very high mortality, especially in the elderly. Whether the mortality benefit of beta-blockers (BB) extends to patients with CHF and lower levels of eGFR remains unknown.

Methods

A population-level administrative database study using linked datasets in Ontario, Canada. Incident CHF cases age > 66 years from April 2002 to March 2014 were included. The date of the first prescription for a BB was the date of inclusion (index date). Patients without evidence of a BB prescription were randomly assigned an index date based on the distribution of index dates for those prescribed a BB. Individuals without an eGFR measure within 1 year prior to the index date, or a prior history of kidney or heart transplant or chronic dialysis were excluded. We matched BB users to non-users (1:1) based on age, sex, eGFR grouping, and a high dimensional propensity score. We examined all-cause mortality using Cox proportional hazards models with BB prescription at baseline and as a time-varying covariate.

Results

Results: After matching, a total of 3,574 pairs were identified. By eGFR category, the number of all-cause mortality events in the BB versus the no beta-blocker (NBB) groups were eGFR > 90: BB 44 (12.7%) vs. NBB 188 (38.6%), eGFR 60-90, BB 357 (14.0%) vs. NBB 1352 (22.2%), eGFR 30-60, BB 274 (19.0%) vs NBB 917 (47.7%), eGFR < 30 BB 47 (20.4%) vs. NBB 166 (53%). Examining baseline BB use, there was no mortality benefit with BB usage in lower eGFR categories [eGFR >90: HR 0.67 (0.48-0.94), eGFR 60-90: HR 0.96 (0.85-1.08), eGFR 30-60: HR 0.96 (0.88-1.05), eGFR <30: HR 0.87 (0.68-1.13), eGFR category X BB interaction p=0.225]. When examining time-varying BB use, it was associated with a similar reduction in all-cause mortality across all eGFR categories [eGFR 90: HR 0.56 (0.39-0.79), eGFR 60-90: HR 0.63 (0.55-0.73), eGFR 30-60: HR 0.59 (0.52-0.66), eGFR <30: HR 0.47 (0.33-0.66), eGFR category X beta-blocker interaction p=0.458].

Conclusion

In elderly patients with CHF, BB use was associated with a similar reduction in mortality across all eGFR categories. Our findings suggest that mortality benefits of BB’s observed in CHF patients included in randomized trials could be extended to patients with eGFR < 30 not on dialysis.

Funding

  • Government Support - Non-U.S.