Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Beta-Blockers Effective, Safe for HFrEF With Renal Dysfunction

Key clinical point: Beta-blocker treatment was effective and safe in patients with heart failure and moderately severe renal dysfunction.

Major finding: The number needed to treat to prevent one death in patients with an estimated glomerular filtration rate of 30-44 mL/min per 1.73 m2 was 21, the same as patients with normal eGFRs.

Study details: An individual patient data meta-analysis for 18,637 heart failure patients from 11 randomized, controlled beta-blocker trials.

Disclosures: Dr. Kotecha has been an advisor to Bayer, a speaker on behalf of Atricure, and has received research funding from GlaxoSmithKline and Menarini. Dr. Jessup had no disclosures.




This analysis of individual patient data is very important and extends our knowledge. The results confirm that beta-blocker treatment reduces mortality in patients with heart failure with reduced ejection fraction (HFrEF) and in sinus rhythm who also have moderately severe renal dysfunction with an estimated glomerular filtration rate as low as 30-44 mL/min per 1.73 m2. This is good news for patients with HFrEF and kidney disease. Clinicians often use comorbidities as a reason not to prescribe or up-titrate beta-blockers. These results show that beta-blockers can be used at guideline-directed dosages, even in patients with renal dysfunction. The findings highlight the importance of not looking for excuses to not treat patients with a beta-blocker. Do not worry about renal function.

The further finding that beta-blockers did not provide a survival benefit in patients with atrial fibrillation can only be considered hypothesis generating for the time being. There is as of yet no evidence that using a beta-blocker in patients with HFrEF and atrial fibrillation is harmful. Ideally, a future randomized study should look into this issue. Until then, I suggest using beta-blockers in these patients, especially because they can help with rate control of the arrhythmia as well as having proven benefits for patients with coronary artery disease or a recent MI.

Theresa A. McDonagh, MD, professor of cardiology at King’s College, London, made these comments as designated discussant for Dr. Kotecha’s report. She had no disclosures.