Prognostic benefits of carvedilol,bisoprolol,and metoprolol controlled release/extended release in hemodialysis patients with heart failure: A 10-year cohort

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 b-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 followup,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 b-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 b-blockers nor renin-angiotensin system antagonists. conclusions-this study demonstrates that the 3 b-blockers were associated with improved survival in long-term hemodialysis patients with heart failure. ( j am heart assoc. 2016;5:e002584 doi: 10.1161/jaha.115.002584) © 2016 the authors.