Heart failure patients with, without CKD fare well with individualized therapies
Risk factors for 1-year mortality in heart failure (HF) patients significantly differ between those with and without chronic kidney disease (CKD), especially with regard to the use of beta-blockers or diuretics at discharge, according to a study. This suggests that these patients may benefit from individualized therapies.
The study included 392 consecutive patients (median age, 79 years; 62 percent male) with acute decompensated HF, among whom 254 (65 percent) had CKD (estimated glomerular filtration rate of <60 mL/min/1.73 m2). HF patients with CKD had significantly higher age, rates of atrial fibrillation or flutter, and rates of history of HF and hypertension relative to those without the comorbidity.
In the entire population, the 1-year mortality rate was 9.2 percent. There was a trend toward higher mortality rate observed in HF patients with vs without CKD, but this difference was not statistically significant (p=0.148).
On multivariable Cox analysis, significant risk factors for 1-year mortality in the HF with CKD group included older age (hazard ratio [HR], 1.070; p=0.016), lower systolic blood pressure at admission (HR, 0.979; p=0.015), discharge medications without beta-blockers (HR, 2.913; p=0.011) and discharge medications without diuretics (HR, 4.414; p<0.001).
On the other hand, factors such as coexisting chronic obstructive pulmonary disease (HR, 10.635; p=0.001) and higher C-reactive protein levels at admission (HR, 1.161; p=0.004) were significantly associated with 1-year mortality among HF patients without CKD.
Kaplan-Meier survival curves revealed that discharge medications with no beta-blockers or diuretics correlated with markedly reduced survival among patients with CKD (p<0.001 for both) but not among those without CKD (p=0.822 and p=0.374, respectively).
Researchers called for additional investigations to elucidate the pathophysiological mechanisms behind the findings to determine more effective individualized therapeutic strategies in patients with HF.