Comparison of Hydralazine/Nitrate and Angiotensin Receptor Neprilysin Inhibitor Use Among Black Versus Nonblack Americans With Heart Failure and Reduced Ejection Fraction (from CHAMP-HF).

Abstract

Underuse of hydralazine/nitrate (HYD/NIT) in black patients with heart failure and reduced ejection fraction (HFrEF) has been previously described, but whether this important treatment gap persists in contemporary practice is unknown. Sacubitril/valsartan has become a part of guideline-directed medical therapy for HFrEF but data on utilization of this therapy in black patients is lacking. This study addressed these issues by assessing the frequency of HYD/NIT and sacubitril/valsartan use in black patients with HFrEF in the Change the Management of Patients with Heart Failure Registry, a multicenter cohort study. The association of race with utilization rates of these agents was also evaluated. Clinical and medication data at baseline and during 12 months of follow-up from black and nonblack registry patients without documented contraindications or intolerance to the medications of interest were analyzed. Data were available from December 2015 to October 2017, in 4,848 HFrEF patients, of whom 853 were black (18%) and 3995 were nonblack. Black patients were younger, more likely to be female, and had lower ejection fractions compared with nonblacks. Only 11% of black patients were receiving HYD/NIT therapy at baseline and 13% at 1 year. The percentage of black patients treated at baseline with sacubitril/valsartan was also low at 18% and remained unchanged at 1 year. After adjustment for covariates, race was independently associated with HYD/NIT use (odds ratio 8.32; 95% confidence interval 6.12 to 11.3; p < 0.0001), but not for sacubitril/valsartan. In conclusion, study findings demonstrate a marked persistent treatment gap for HYD/NIT and similar poor utilization of sacubitril/valsartan in black patients with HFrEF despite current guideline recommendations.

• Authors: Erika M Giblin, Kirkwood F Adams Jr, Larry Hill, Gregg C Fonarow, Fredonia B Williams, Puza P Sharma, Nancy M Albert, Javed Butler, Adam D DeVore, Carol I Duffy, Adrian F Hernandez, Kevin McCague, John A Spertus, Laine Thomas, J Herbert Patterson
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 124 Issue 12 Pg. 1900-1906 (12 15 2019) ISSN: 1879-1913 [Electronic] United States
• PMID: 31679641 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Aminobutyrates
• Angiotensin Receptor Antagonists
• Biphenyl Compounds
• Drug Combinations
• Tetrazoles
• Hydralazine
• Valsartan
• Neprilysin
• sacubitril and valsartan sodium hydrate drug combination

Topics

• Black or African American (statistics & numerical data)
• Aged
• Aminobutyrates (administration & dosage)
• Angiotensin Receptor Antagonists (therapeutic use)
• Biphenyl Compounds
• Cohort Studies
• Drug Combinations
• Drug Utilization
• Female
• Heart Failure (diagnosis, drug therapy, ethnology)
• Humans
• Hydralazine (therapeutic use)
• Male
• Middle Aged
• Neprilysin (therapeutic use)
• Prognosis
• Registries
• Retrospective Studies
• Risk Assessment
• Stroke Volume (drug effects)
• Survival Rate
• Tetrazoles (administration & dosage)
• Treatment Outcome
• Valsartan