Abstract
Current evidence suggests that beta-blocker lower the risk of development of atrial fibrillation (AF) and in-hospital stroke after cardiac surgery. This study was to assess whether beta-blockers could decrease incidence of new-onset AF in patients with end stage renal disease (ESRD). We identified patients from a nation-wide database called Registry for Catastrophic Illness, which encompassed almost 100% of the patients receiving dialysis therapy in Taiwan from 1995 to 2008. Propensity score matching and Cox’s proportional hazards regression model were used to estimate hazard ratios (HRs) for new-onset AF. Among 100066 patients, 41.7% received beta-blockers. After a median follow-up of 1500 days, the incidence of new-onset AF significantly decreased in patients treated with beta-blockers (HR = 0.483, 95% confidence interval = 0.437-0.534). The prevention of new-onset AF was significantly better in patients taking longer duration of beta-blockers therapy (P for time trend <0.001). The AF prevention effect remains robust in subgroup analyses. In conclusion, beta-blockers seem effective in the primary prevention of AF in ESRD patients. Hence, beta-blockers may be the target about upstream treatment of AF.
Highlights
Atrial stretch and fibrosis[19]
Patients not receiving betablocker treatment were served as control group
The prevalence of receiving hemodialysis therapy was significantly higher in beta-blocker group (98.5%) than in control group (85.6%)
Summary
Pathological activation of renin-angiotensin-aldosterone system and systemic inflammation create the required substrate for development of AF20,21. It is not clear whether patients with perioperative status and ESRD share common etiologies for AF, but both conditions have many similar factors prone to the development of AF. In the AFFIRM study, beta-blockers were the most effectively and commonly used drug class for rate control[22]. Current guidelines recommend beta-blockers as one of rate control drugs, especially useful in the presence of high adrenergic tone or myocardium ischemia[23,24]. There is a paucity of studies concerning the role of beta-blockers on prophylactic effect for AF in ESRD patients. We hypothesized that patients receiving beta-blockers would be associated with lower AF risks
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