Use of Hydralazine-Isosorbide Dinitrate Combination in African American and Other Race/Ethnic Group Patients With Heart Failure and Reduced Left Ventricular Ejection Fraction

• Type of Material: Article
• Authors: Harsh B. Golwala, Oklahoma University; Udho Thadani, Oklahoma University; Li Liang, Duke Clinical Research Institute; Stavros Stavrakis, Oklahoma University; Javed Butler, Emory University; Clyde W. Yancy, Northwestern University; Deepak L. Bhatt, Harvard University; Adrian F. Hernandez, Duke Clinical Research Institute; Gregg C. Fonarow, Ronald Reagan UCLA Med Ctr
• Language: English
• Date: 2013-08-01
• Publisher: Wiley Open Access: Creative Commons Attribution Non-Commercial
• Publication Version: Final Published Version
• Copyright Statement: © 2013 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley-Blackwell.
• License: Creative Commons Attribution-Noncommercial 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.113.000214
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 2
• Issue: 4
• Start Page: e000214
• End Page: e000214
• Grant/Funding Information: The Get With The Guidelines–Heart Failure (GWTG‐HF) program is provided by the American Heart Association. GWTG‐HF has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho‐McNeil, and the American Heart Association Pharmaceutical Roundtable.
• Keywords: Cardiovascular System & Cardiology; GENDER; Life Sciences & Biomedicine; SURVIVAL; Science & Technology; race/ethnicity; quality; CARVEDILOL; ENALAPRIL; registry; guideline adherence; HF; MORTALITY; GUIDELINES; Cardiac & Cardiovascular Systems; RANDOMIZED-TRIAL; MORBIDITY; ASSOCIATION; heart failure
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

BACKGROUND: Hydralazine-isosorbide dinitrate (H-ISDN) therapy is recommended for African American patients with moderate to severe heart failure with reduced ejection fraction (<40%) (HFrEF), but use, temporal trends, and clinical characteristics associated with H-ISDN therapy in clinical practice are unknown. METHODS AND RESULTS: An observational analysis of 54 622 patients admitted with HFrEF and discharged home from 207 hospitals participating in the Get With The Guidelines-Heart Failure registry from April 2008 to March 2012 was conducted to assess prescription, trends, and predictors of use of H-ISDN among eligible patients. Among 11 185 African American patients eligible for H-ISDN therapy, only 2500 (22.4%) received H-ISDN therapy at discharge. In the overall eligible population, 5115 of 43 498 (12.6%) received H-ISDN at discharge. Treatment rates increased over the study period from 16% to 24% among African Americans and from 10% to 13% among the entire HFrEF population. In a multivariable model, factors associated with H-ISDN use among the entire cohort included younger age; male sex; African American/Hispanic ethnicity; and history of diabetes, hypertension, anemia, renal insufficiency, higher systolic blood pressure, and lower heart rate. In African American patients, these factors were similar; in addition, being uninsured was associated with lower use. CONCLUSIONS: Overall, few potentially eligible patients with HFrEF are treated with H-ISDN, and among African-Americans fewer than one-fourth of eligible patients received guideline-recommended H-ISDN therapy. Improved ways to facilitate use of H-ISDN therapy in African American patients with HFrEF are needed.