Renal insufficiency and heart failure
The association among renal insufficiency, pharmacotherapy, and outcomes in 6,427 patients with heart failure and coronary artery disease

https://doi.org/10.1016/j.jacc.2004.06.072Get rights and content
Under an Elsevier user license
open archive

Objectives

This study was designed to examine the use of cardiovascular medications and outcomes in patients with heart failure (HF) and renal dysfunction.

Background

Renal insufficiency is associated with poorer outcomes in patients with HF, but the mechanisms are uncertain. In particular, the degree of therapeutic nihilism in these patients, and whether it is appropriate, is unclear.

Methods

This was a prospective cohort study with a one-year follow-up.

Results

In 6,427 patients with cardiologist-diagnosed HF and angiographically proven coronary artery disease (mean age 69 years; 65% men; one-year mortality, 10%), 39% had creatinine clearances <60 ml/min. Patients with renal insufficiency were less likely to be prescribed angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, statins, or aspirin (all p < 0.001). However, users of aspirin (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.57 to 0.85), statins (OR 0.79, 95% CI 0.64 to 0.97), and beta-blockers (OR 0.75, 95% CI 0.62 to 0.90) were less likely to die in the subsequent 12 months than nonusers, irrespective of renal function (all OR adjusted for covariates including atherosclerotic burden and ejection fraction). Although ACE inhibitor users with creatinine clearances ≥60 ml/min had lower 12-month mortality (OR 0.72, 95% CI 0.48 to 0.99), ACE inhibitor users with clearances <60 ml/min did not (OR 1.21, 95% CI 0.97 to 1.51).

Conclusions

Renal insufficiency is common in patients with HF and coronary artery disease, and these patients have more advanced coronary atherosclerosis. Patients with renal insufficiency are less likely to be prescribed efficacious therapies, but have better outcomes if they receive these medications.

Abbreviations and acronyms

ACE
angiotensin-converting enzyme
CAD
coronary artery disease
CI
confidence interval
HF
heart failure
LV
left ventricular
OR
odds ratio

Cited by (0)

Drs. McAlister, Tonelli, and Ghali are supported by the Alberta Heritage Foundation for Medical Research; Dr. McAlister is also supported by the Canadian Institutes of Health Research. Ms. Humphries is supported by the Michael Smith Foundation and Dr. Ghali is also supported by a Canada Research Chair. The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Initiative is supported by the Weston Foundation, Merck Frosst Canada Inc., Guidant Corporation, Boston Scientific Ltd., Hoffman-La Roche Ltd., and Johnson and Johnson Inc.-Cordis.