title: Prognostic Benefits of Carvedilol, Bisoprolol, and Metoprolol Controlled Release/Extended Release in Hemodialysis Patients with Heart Failure: A 10-Year Cohort.
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 β-blockers and their associations with mortality.
  
  
  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 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 β-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 β-blockers nor renin-angiotensin system antagonists.
  
  
  CONCLUSIONS
  This study demonstrates that the 3 β-blockers were associated with improved survival in long-term hemodialysis patients with heart failure.
authors.affiliation: School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan (C.H.T.).
authors.forename: Chao-Hsiun
authors.initials: CH
authors.lastname: Tang
authors.affiliation: School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (C.C.W.).
authors.forename: Chia-Chen
authors.initials: CC
authors.lastname: Wang
authors.affiliation: School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (T.H.C., C.Y.H., Y.M.S.) Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (T.H.C., C.Y.H., Y.M.S.).
authors.forename: Tso-Hsiao
authors.initials: TH
authors.lastname: Chen
authors.affiliation: School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (T.H.C., C.Y.H., Y.M.S.) Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (T.H.C., C.Y.H., Y.M.S.).
authors.forename: Chuang-Ye
authors.initials: CY
authors.lastname: Hong
authors.affiliation: School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (T.H.C., C.Y.H., Y.M.S.) Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (T.H.C., C.Y.H., Y.M.S.).
authors.forename: Yuh-Mou
authors.initials: YM
authors.lastname: Sue
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D017298:Bisoprolol / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D002227:Carbazoles / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D000077261:Carvedilol; D016009:Chi-Square Distribution; D016208:Databases, Factual; D003692:Delayed-Action Preparations; D004339:Drug Compounding; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008790:Metoprolol / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D011412:Propanolamines / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D057216:Propensity Score; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002227:Carbazoles; D003692:Delayed-Action Preparations; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol; D017298:Bisoprolol
keywords: end‐stage renal disease; heart failure; hemodialysis; mortality; β‐blocker