Use of hydralazine-isosorbide dinitrate combination in African American and other race/ethnic group patients with heart failure and reduced left ventricular ejection fraction.

Journal Article (Journal Article;Multicenter Study)

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.

Full Text

Duke Authors

Cited Authors

  • Golwala, HB; Thadani, U; Liang, L; Stavrakis, S; Butler, J; Yancy, CW; Bhatt, DL; Hernandez, AF; Fonarow, GC

Published Date

  • August 21, 2013

Published In

Volume / Issue

  • 2 / 4

Start / End Page

  • e000214 -

PubMed ID

  • 23966379

Pubmed Central ID

  • PMC3828812

Electronic International Standard Serial Number (EISSN)

  • 2047-9980

Digital Object Identifier (DOI)

  • 10.1161/JAHA.113.000214


  • eng

Conference Location

  • England