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Comparison between beta‐blockers and calcium channel blockers in patients with atrial fibrillation according to renal function.

Comparison between beta‐blockers and calcium channel blockers in patients with atrial fibrillation according to renal function.

Authors :
Parada Barcia, José Antonio
Raposeiras Roubin, Sergio
Fernández, David González
García, André González
Otero, Carla Iglesias
González Bermúdez, Inmaculada
Íñiguez Romo, Andrés
Abu‐Assi, Emad
Source :
Clinical Cardiology; May2024, Vol. 47 Issue 5, p1-6, 6p
Publication Year :
2024

Abstract

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. Key points: Rate control is the most commonly employed first‐line management strategy for atrial fibrillation in patients with chronic kidney disease. Evidence to guide selection between beta‐blockers and nondihydropyridine calcium channel blockers is scarce.This is the first study to compare patients with atrial fibrillation under rate‐control strategy according to renal function.In patients with glomerular filtration rate (GFR) ≥ 30 mL/min/1.73 m2, both nondihydropyridine calcium channel blockers (ND‐CCB) and beta‐blockers therapy have good results in heart rate (HR) control, while in advanced chronic kidney disease (GFR < 30 mL/min/1.73 m2), a possible association of ND‐CCB with increased hospitalizations due to poor HR control was detected. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
01609289
Volume :
47
Issue :
5
Database :
Complementary Index
Journal :
Clinical Cardiology
Publication Type :
Academic Journal
Accession number :
177510450
Full Text :
https://doi.org/10.1002/clc.24257