MERIT - HF Subanalysis in CHF Patients with Renal Dysfunction

Aim

To evaluate the benefits of metoprolol extended release (ER) in HF patients with renal impairment.

Method

Analysis of The Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF)

Study Patients

NYHA class II-IV HF patients with ejection fraction <40% (N = 3965)

Patients were divided in three groups on basis of estimated glomerular filtration rate (eGFR)

eGFR < 45 ml/min/1.73 m² (n = 493)
eGFR = 45-60 ml/min/1.73 m² (n = 976)
eGFR > 60 ml/min/1.73 m² (n = 2496)

Study Drugs

Metoprolol ER vs placebo

Metoprolol was initiated at 25 mg OD (NYHA class II), or 12.5 mg OD (NYHA class III or IV), titrated up to a target dosage of 200 mg OD

Efficacy Endpoints

Composite of all-cause mortality & hospitalization for HF
Hospitalization due to worsening of HF
Composite of cardiac death/nonfatal MI

Results

Significant reduction in composite outcome of all-cause mortality/CHF hospitalization; greater benefits observed with increasing degree of renal impairment

Significant reduction in hospitalization due to worsening HF with metoprolol ER

Significant risk reduction in composite of cardiac death/nonfatal MI with metoprolol ER

Number needed to treat with metoprolol ER

Safety

Metoprolol ER was well tolerated in all three renal function groups.

Conclusion

Metoprolol ER significantly reduces mortality & hospitalization in CHF patients with renal dysfunction.

J Cardiac Fail 2009;15:310-8