Author + information
- Received November 21, 2016
- Revision received April 24, 2017
- Accepted April 25, 2017
- Published online August 28, 2017.
- aDivision of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
- bDivision of Cardiology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- cAhmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles Medical Center, Los Angeles, California
- dDivision of Cardiology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
- ↵∗Address for correspondence:
Dr. Paul A. Heidenreich, Veterans Administration Palo Alto Healthcare System, 111C Cardiology, 3801 Miranda Avenue, Palo Alto, California 94306.
Objectives This study sought to evaluate the effectiveness of hydralazine–isosorbide dinitrate (H-ISDN) in African Americans with heart failure (HF) with reduced ejection fraction (HFrEF).
Background Among African-American patients with HFrEF, H-ISDN was found to improve quality of life and lower HF-related hospitalization and mortality rates in the A-HEFT (African-American Heart Failure Trial). Few studies have evaluated the effectiveness of this therapy in clinical practice.
Methods Veterans Affairs patients with a hospital admission for HF between 2007 and 2013 were screened. Inclusion criteria included African-American race, left ventricular ejection fraction <40%, and receipt of Veterans Affairs medications. Exclusions were documented contraindications to H-ISDN, creatinine >2.0 mg/dl, or intolerance to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Adjusted hazard ratios were calculated for patients who received H-ISDN 6-months before admission compared with patients who did not receive H-ISDN, by using inverse probability weighting of propensity scores and a time to death analysis for 18 months of follow-up. Propensity scores were generated using patients’ characteristics, left ventricular ejection fraction, laboratory values, and hospital characteristics.
Results The final cohort included 5,168 African-American patients with HF (mean age 65.2 years), with 15.2% treated with H-ISDN before index admission. After 18 months, there were 1,275 reported deaths (24.7%). The adjusted mortality rate at 18 months was 22.1% for patients receiving H-ISDN treatment and 25.2% for untreated patients (p = 0.009); adjusted hazard ratio: 0.85 (95% confidence interval: 0.73 to 1.00; p = 0.057).
Conclusions H-ISDN remains underused in African-American patients with HFrEF. In this cohort, the study found that H-ISDN use was associated with lower mortality rates in African-American patients with HFrEF when controlling for patient selection by using an inverse probability weighting of propensity scores.
- heart failure
- heart failure with reduced ejection fraction
Dr. Ziaeian was supported by the National Institutes of Health Cardiovascular Scientist Training Program (T32 HL007895). Dr. Fonarow has received research support from the National Institutes of Health; and has done consulting for Amgen, Janssen, Medtronic, Novartis, and St. Jude Medical. Dr. Heidenreich has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received November 21, 2016.
- Revision received April 24, 2017.
- Accepted April 25, 2017.