Efficacy and safety of nebivolol in elderly heart failure patients with impaired renal function: insights from the SENIORS trial

Abstract

AimTo determine the safety and efficacy of nebivolol in elderly heart failure (HF) patients with renal dysfunction.Methods and resultsSENIORS recruited patients aged 70 years or older with symptomatic HF, irrespective of ejection fraction, and randomized them to nebivolol or placebo. Patients (n = 2112) were divided by tertile of estimated glomerular filtration rate (eGFR). Mean age of patients was 76.1 years, 35% of patients had an ejection fraction of >35%, and 37% were women resulting in a unique cohort, far more representative of clinical practice than previous trials. eGFR was strongly associated with outcomes and nebivolol was similarly efficacious across eGFR tertiles. The primary outcome rate (all-cause mortality or cardiovascular hospital admission) and adjusted hazard ratio for nebivolol use in those with low eGFR was 40% and 0.84 (95% CI 0.67–1.07), 31% and 0.79 (0.60–1.04) in the middle tertile, and 29% and 0.86 (0.65–1.14) in the highest eGFR tertile. There was no interaction noted between renal function and the treatment effect (P = 0.442). Nebivolol use in patients with moderate renal impairment (eGFR <60) was not associated with major safety concerns, apart from higher rates of drug-discontinuation due to bradycardia.ConclusionNebivolol is safe and has a similar effect in elderly HF patients with mild or moderate renal impairment.

Referral to sub-specialists: who have the most to gain from early specialist intervention among patients with markers of renal disease?

“…[27][28][29][30] b blockers reduce the risk of mortality, myocardial infarction and heart failure (chronic heart failure) in patients with CKD. [31][32][33][34] A low-protein diet has not reduced the risk of mortality or ESRD compared with a usual protein diet, at least in the course of CKD stages 1-3. [35][36][37][38][39] Screening for patients with chronic kidney disease stage 1-3: facts and fallacies…”

Beta-adrenoblockers of third generation as medicines for drug therapy of patients with chronic kidney disease

“…Риск достижения конечной точки составил при этом 0,86 (р < 0,001) в группе лиц с относитель-но сохраненной функцией почек, 0,79 (р < 0,001) во 2-й группе и 0,84 (р < 0,001) в группе пациентов с СКФ 43,3 мл/мин/1,73 м 2 . Назначение небиволола пожилым больным ХСН с СКФ < 60 мл/мин/1,73 м 2 не ухудшало безопасность лечения, за исключением некоторого увеличения числа отказов от его приема из-за выраженной брадикардии [12].…”

Northern Territory Perspectives on Heart Failure with Comorbidities – Understanding Trial Validity and Exploring Collaborative Opportunities to Broaden the Evidence Base

“…Like those with diabetes, patients with renal disease are often excluded from heart failure trials because of concerns of adverse effects or prognosis [19]. Yet, post hoc analysis from larger studies, like the SENIORS have suggested that the relative benefits intervention may be at least similar in patients with renal impairment when compared to those with isolated CHF [20], meaning in absolute terms intervention may be greater than other clinical settings. However, further evidence is required before contraindications for many agents in patients with renal disease can be relaxed.…”