Prognostic Benefits of Carvedilol, Bisoprolol, and Metoprolol Controlled Release/Extended Release in Hemodialysis Patients with Heart Failure

A 10-Year Cohort

Chao-Hsiun Tang, Chia Chen Wang, Tso-Hsiao Chen, Chuang Ye Hong, Yuh-Mou Sue

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

BACKGROUND: Heart failure is a highly prevalent cardiovascular complication among patients receiving long-term hemodialysis, but the benefits of carvedilol, bisoprolol, and metoprolol controlled release/extended release on the outcomes of these patients remain unclear. In this study, we address the use of these 3 β-blockers and their associations with mortality.

METHODS AND RESULTS: Long-term hemodialysis patients, aged ≥35 years, with new-onset heart failure and receiving various medications were identified through the use of 1999-2010 data from the Taiwan National Health Insurance Research Database. From the total of 4435 heart failure patients, we selected 1700 new users of the 3 β-blockers (study group) and 1700 nonusers (control group), by using matched cohorts according to their propensity scores, and then compared the 5-year all-cause mortality rates by using Cox proportional hazard regressions and time-dependent covariate adjustment. During 3944 person-years of follow-up, 666 (39.2%) deaths occurred within the study group, compared with 918 (54%) deaths during 2893 person-years of follow-up in the control group. The 5-year mortality rate for the study (control) group was 54.5% (70.3%); P<0.001. Adjusted hazard regression analyses revealed that the therapeutic effects of β-blockers remained significant for all-cause mortality (hazard ratio 0.80, 95% CI 0.72 to 0.90). Subgroup analyses revealed that patients in the study group receiving β-blockers plus renin-angiotensin system antagonists exhibited the lowest mortality rate, while the highest mortality rate was found among patients in the control group receiving neither β-blockers nor renin-angiotensin system antagonists.

CONCLUSIONS: This study demonstrates that the 3 β-blockers were associated with improved survival in long-term hemodialysis patients with heart failure.

Original languageEnglish
JournalJournal of the American Heart Association
Volume5
Issue number1
DOIs
Publication statusPublished - Jan 2016

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Bisoprolol
Metoprolol
antineoplaston A10
Renal Dialysis
Heart Failure
Mortality
Control Groups
Renin-Angiotensin System
Propensity Score
National Health Programs
Therapeutic Uses
carvedilol
Taiwan
Regression Analysis
Databases
Survival

Keywords

  • Journal Article
  • Research Support, Non-U.S. Gov't

Cite this

@article{fccf3949e614418b98731202d5ca9ce0,
title = "Prognostic Benefits of Carvedilol, Bisoprolol, and Metoprolol Controlled Release/Extended Release in Hemodialysis Patients with Heart Failure: A 10-Year Cohort",
abstract = "BACKGROUND: Heart failure is a highly prevalent cardiovascular complication among patients receiving long-term hemodialysis, but the benefits of carvedilol, bisoprolol, and metoprolol controlled release/extended release on the outcomes of these patients remain unclear. In this study, we address the use of these 3 β-blockers and their associations with mortality.METHODS AND RESULTS: Long-term hemodialysis patients, aged ≥35 years, with new-onset heart failure and receiving various medications were identified through the use of 1999-2010 data from the Taiwan National Health Insurance Research Database. From the total of 4435 heart failure patients, we selected 1700 new users of the 3 β-blockers (study group) and 1700 nonusers (control group), by using matched cohorts according to their propensity scores, and then compared the 5-year all-cause mortality rates by using Cox proportional hazard regressions and time-dependent covariate adjustment. During 3944 person-years of follow-up, 666 (39.2{\%}) deaths occurred within the study group, compared with 918 (54{\%}) deaths during 2893 person-years of follow-up in the control group. The 5-year mortality rate for the study (control) group was 54.5{\%} (70.3{\%}); P<0.001. Adjusted hazard regression analyses revealed that the therapeutic effects of β-blockers remained significant for all-cause mortality (hazard ratio 0.80, 95{\%} CI 0.72 to 0.90). Subgroup analyses revealed that patients in the study group receiving β-blockers plus renin-angiotensin system antagonists exhibited the lowest mortality rate, while the highest mortality rate was found among patients in the control group receiving neither β-blockers nor renin-angiotensin system antagonists.CONCLUSIONS: This study demonstrates that the 3 β-blockers were associated with improved survival in long-term hemodialysis patients with heart failure.",
keywords = "Journal Article, Research Support, Non-U.S. Gov't",
author = "Chao-Hsiun Tang and Wang, {Chia Chen} and Tso-Hsiao Chen and Hong, {Chuang Ye} and Yuh-Mou Sue",
note = "{\circledC} 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.",
year = "2016",
month = "1",
doi = "10.1161/JAHA.115.002584",
language = "English",
volume = "5",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Prognostic Benefits of Carvedilol, Bisoprolol, and Metoprolol Controlled Release/Extended Release in Hemodialysis Patients with Heart Failure

T2 - A 10-Year Cohort

AU - Tang, Chao-Hsiun

AU - Wang, Chia Chen

AU - Chen, Tso-Hsiao

AU - Hong, Chuang Ye

AU - Sue, Yuh-Mou

N1 - © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

PY - 2016/1

Y1 - 2016/1

N2 - BACKGROUND: Heart failure is a highly prevalent cardiovascular complication among patients receiving long-term hemodialysis, but the benefits of carvedilol, bisoprolol, and metoprolol controlled release/extended release on the outcomes of these patients remain unclear. In this study, we address the use of these 3 β-blockers and their associations with mortality.METHODS AND RESULTS: Long-term hemodialysis patients, aged ≥35 years, with new-onset heart failure and receiving various medications were identified through the use of 1999-2010 data from the Taiwan National Health Insurance Research Database. From the total of 4435 heart failure patients, we selected 1700 new users of the 3 β-blockers (study group) and 1700 nonusers (control group), by using matched cohorts according to their propensity scores, and then compared the 5-year all-cause mortality rates by using Cox proportional hazard regressions and time-dependent covariate adjustment. During 3944 person-years of follow-up, 666 (39.2%) deaths occurred within the study group, compared with 918 (54%) deaths during 2893 person-years of follow-up in the control group. The 5-year mortality rate for the study (control) group was 54.5% (70.3%); P<0.001. Adjusted hazard regression analyses revealed that the therapeutic effects of β-blockers remained significant for all-cause mortality (hazard ratio 0.80, 95% CI 0.72 to 0.90). Subgroup analyses revealed that patients in the study group receiving β-blockers plus renin-angiotensin system antagonists exhibited the lowest mortality rate, while the highest mortality rate was found among patients in the control group receiving neither β-blockers nor renin-angiotensin system antagonists.CONCLUSIONS: This study demonstrates that the 3 β-blockers were associated with improved survival in long-term hemodialysis patients with heart failure.

AB - BACKGROUND: Heart failure is a highly prevalent cardiovascular complication among patients receiving long-term hemodialysis, but the benefits of carvedilol, bisoprolol, and metoprolol controlled release/extended release on the outcomes of these patients remain unclear. In this study, we address the use of these 3 β-blockers and their associations with mortality.METHODS AND RESULTS: Long-term hemodialysis patients, aged ≥35 years, with new-onset heart failure and receiving various medications were identified through the use of 1999-2010 data from the Taiwan National Health Insurance Research Database. From the total of 4435 heart failure patients, we selected 1700 new users of the 3 β-blockers (study group) and 1700 nonusers (control group), by using matched cohorts according to their propensity scores, and then compared the 5-year all-cause mortality rates by using Cox proportional hazard regressions and time-dependent covariate adjustment. During 3944 person-years of follow-up, 666 (39.2%) deaths occurred within the study group, compared with 918 (54%) deaths during 2893 person-years of follow-up in the control group. The 5-year mortality rate for the study (control) group was 54.5% (70.3%); P<0.001. Adjusted hazard regression analyses revealed that the therapeutic effects of β-blockers remained significant for all-cause mortality (hazard ratio 0.80, 95% CI 0.72 to 0.90). Subgroup analyses revealed that patients in the study group receiving β-blockers plus renin-angiotensin system antagonists exhibited the lowest mortality rate, while the highest mortality rate was found among patients in the control group receiving neither β-blockers nor renin-angiotensin system antagonists.CONCLUSIONS: This study demonstrates that the 3 β-blockers were associated with improved survival in long-term hemodialysis patients with heart failure.

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1161/JAHA.115.002584

DO - 10.1161/JAHA.115.002584

M3 - Article

VL - 5

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 1

ER -