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Published on: July 3, 2013
Comparison between beta-blockers and calcium channel blockers in patients with atrial fibrillation according to renal
José Antonio Parada Barcia1,2, Sergio Raposeiras Roubin1,3,4, David González Fernández1
1Cardiology Department, University Hospital Alvaro Cunqueiro, Vigo, Spain.
Insights
Beta-blockers (BB) and nondihydropyridine calcium channel blockers (ND-CCB) showed similar hospitalization rates for atrial fibrillation (AF) in patients with moderate chronic kidney disease (CKD). However, ND-CCB use was linked to higher hospitalizations in severe CKD patients.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Atrial fibrillation (AF) management in chronic kidney disease (CKD) often involves rate control.
- Beta-blockers (BB) and nondihydropyridine calcium channel blockers (ND-CCB) are primary agents for heart rate (HR) control in AF.
- Limited research exists on the comparative efficacy of BB versus ND-CCB in CKD patients.
Purpose of the Study:
- To compare hospitalizations due to poor HR control in AF patients on rate-control therapy.
- To analyze differences based on glomerular filtration rate (GFR) levels.
- To evaluate the safety and effectiveness of BB and ND-CCB in CKD.
Main Methods:
- Retrospective cohort study of 2804 AF patients from January 2014 to April 2020.
- Patients were treated with either BB or ND-CCB for rate control.
- Hospitalizations for rapid ventricular response (RVR), slow ventricular response (SVR), or pacemaker insertion were the primary endpoints, analyzed using competing risk regression.
Main Results:
- No significant difference in hospitalizations between BB and ND-CCB for GFR > 60 mL/min/1.73 m² (sHR 0.850, p=0.442).
- No significant difference for GFR 30-59 mL/min/1.73 m² (sHR 1.242, p=0.333).
- Increased hospitalizations for poor HR control were observed with ND-CCB in patients with GFR < 30 mL/min/1.73 m² (sHR 4.53, p=0.026).
Conclusions:
- For AF patients with GFR ≥ 30 mL/min/1.73 m², the choice between ND-CCB and BB did not impact hospitalizations for poor HR control.
- A potential association between ND-CCB use and increased hospitalizations for poor HR control was noted in patients with GFR < 30 mL/min/1.73 m².
- Further research is warranted to investigate the specific effects of these agents in patients with severely impaired kidney function (GFR < 30 mL/min/1.73 m²).
Background:
Rate control is the most commonly employed first-line management strategy for atrial fibrillation (AF) in patients with chronic kidney disease (CKD). Principal agents used to control heart rate (HR) include beta-blockers (BB) and nondihydropyridine calcium channel blockers (ND-CCB). However, there is a paucity of published studies of the differences between those drugs in CKD patients.
Hypothesis:
The present study aimed to investigate the differences, in terms of hospitalizations due to a poor HR control, in patients with AF under a rate-control strategy according to glomerular filtration rate (GFR).
Methods:
The study cohort included 2804 AF patients under rate-control regime (BB or ND-CCB) between January 2014 and April 2020. The end point, determined by competing risk regression, was hospitalizations for AF with rapid ventricular response (RVR), slow ventricular response (SVR), and need for pacemaker.
Results:
On multivariate analysis, there were no statistical differences between ND-CCB and BB for subjects with GFR > 60 mL/min/1.73 m2 (subdistribution heart rate [sHR] 0.850, 95% confidence interval [CI]: 0.61-1.19; p = .442) and GFR 30-59 mL/min/1.73 m2 (sHR 1.242, 95% CI: 0.80-1.63; p = .333), while in patients with GFR < 30 mL/min/1.73 m2, ND-CCB therapy was associated with increased hospitalizations due to poor HR control (sHR 4.53, 95% CI: 1.19-17.18; p = .026).
Conclusion:
In patients with GFR ≥ 30 mL/min/1.73 m2, the choice of ND-CCB or BB had no impact on hospitalizations due to poor HR control, while in GFR < 30 mL/min/1.73 m2, a possible association was detected. The effects of these drugs on GFR < 30 mL/min/1.73 m2 would require further investigation.
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