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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 ?-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 ?-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 ?-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 ?-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 ?-blockers nor renin-angiotensin system antagonists.Conclusions
This study demonstrates that the 3 ?-blockers were associated with improved survival in long-term hemodialysis patients with heart failure.
SUBMITTER: Tang CH
PROVIDER: S-EPMC4859376 | biostudies-literature | 2016 Jan
REPOSITORIES: biostudies-literature
Tang Chao-Hsiun CH Wang Chia-Chen CC Chen Tso-Hsiao TH Hong Chuang-Ye CY Sue Yuh-Mou YM
Journal of the American Heart Association 20160106 1
<h4>Background</h4>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.<h4>Methods and results</h4>Long-term hemodialysis patients, aged ≥35 years, with new-onset heart failure and receiving various m ...[more]