Bisoprolol use was associated with lower 1-year mortality compared to metoprolol succinate in individuals with HFrEF and end-stage renal disease (ESRD). The study, published in Circulation, assessed real-world outcomes using a large US electronic health record network.

A retrospective cohort analysis identified adults with HFrEF and ESRD initiating bisoprolol or metoprolol succinate between 2004 and 2023. After exclusion of prior dual exposure and one-to-one propensity score matching on demographics, comorbidities, and cardiovascular medications, 133 matched participants were included per group. Outcomes included all-cause mortality (MACE) myocardial infarction, stroke, or death), 4-point MACE (MACE plus angina), hospitalization, and kidney transplantation.

Bisoprolol was associated with lower 1-year all-cause mortality (17.1% vs 29.7%; hazard ratio (HR) 0.58; 95% CI 0.34–0.99). Differences in MACE (19.7% vs 29.9%; HR 0.70; 95% CI 0.36–1.35) and 4-point MACE (16.4% vs 27.9%; HR 0.63; 95% CI 0.30–1.32) were not statistically significant. Hospitalization rates were comparable between treatments.

The findings suggest a potential survival benefit with bisoprolol in this high-risk population, indicating the need for prospective evaluation.