Racial Differences in Diuretic Efficiency, Plasma Renin, and Rehospitalization in Subjects With Acute Heart Failure

• Type of Material: Article
• Authors: Alanna Morris, Emory University; Aditi Nayak, Emory University; Yi-An Ko, Emory University; Melroy D'Souza, Emory University; Michael G Felker, Duke University; Margaret M Redfield, Mayo Clinic; Wilson Wh Tang, Cleveland Clinic; Jeffrey M Testani, Yale University; Javed Butler, Emory University
• Language: English
• Date: 2020-07-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020, Wolters Kluwer Health
• Final Published Version (URL): http://dx.doi.org/10.1161/CIRCHEARTFAILURE.119.006827
• Title of Journal or Parent Work: CIRCULATION-HEART FAILURE
• Volume: 13
• Issue: 7
• Start Page: 84
• End Page: 94
• Grant/Funding Information: Dr. Morris has received research grants from NHLBI (NIH K23 HL124287 and R03 HL146874) and the Robert Wood Johnson Foundation (Harold Amos Medical Faculty Development Program).; Dr. Felker has received research grants from NHLBI (NIH U-10 HL110312) and American Heart Association.; Dr. Tang has received research grants from NIDDK (R01 DK106000) and NHLBI (HL 126827).; Dr. Testani has received research grants from NHLBI (NIH R01 HL128973, R01 139629, and R01 HL148354).
• Keywords: WHITES; SYSTEM; SODIUM; race factors; heart failure; Cardiac & Cardiovascular Systems; Science & Technology; TRIAL; Life Sciences & Biomedicine; THIRST; disparities; BLACKS; STRATEGIES; OUTCOMES; renin; CLINICAL CHARACTERISTICS; humans; diuretics; Cardiovascular System & Cardiology

Abstract

Background: Black patients have higher rates of hospitalization for acute heart failure than other race/ethnic groups. We sought to determine whether diuretic efficiency is associated with racial differences in risk for rehospitalization after acute heart failure. Methods: A post hoc analysis was performed on 721 subjects (age, 68±13 years; 22% black) enrolled in 3 acute heart failure clinical trials: ROSE-AHF (Renal Optimization Strategies Evaluation in Acute Heart Failure), DOSE-AHF (Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure), and CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure). Repeated-measures ANOVA was used to test for a race×time effect on measures of decongestion. Diuretic efficiency was calculated as net fluid balance per total furosemide equivalents. In a subset of subjects, Cox regression was used to examine the association between race and rehospitalization according to plasma renin activity (PRA). Results: Compared with nonblack patients, black patients were younger and more likely to have nonischemic heart failure. During the first 72 to 96 hours, there was greater fluid loss (P=0.001), decrease in NT-proBNP (N-terminal pro-B-type natriuretic peptide; P=0.002), and lower levels of PRA (P<0.0001) in black patients. Diuretic efficiency was higher in black than in nonblack patients (403 [interquartile range, 221-795] versus 325 [interquartile range, 154-698]; P=0.014). However, adjustment for baseline PRA attenuated the association between black race and diuretic efficiency. Over a median follow-up of 68 (interquartile range, 56-177) days, there was an increased risk of all-cause and heart failure-specific rehospitalization in nonblack patients with increasing levels of PRA, while the risk of rehospitalization was relatively constant across levels of PRA in black patients. Conclusions: Higher diuretic efficiency in black patients with acute heart failure may be related to racial differences in activity of the renin-angiotensin-aldosterone system.