Lena Mathews1,2, Ning Ding3, Yingying Sang3, Laura R Loehr4, Jung-Im Shin3, Naresh M Punjabi3,5, Alain G Bertoni6, Deidra C Crews3,7,8, Wayne D Rosamond4, Josef Coresh3, Chiadi E Ndumele9,3,8, Kunihiro Matsushita9,3, Patricia P Chang4,10. 1. Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street Blalock 524D, Baltimore, MD, 21287, USA. lmathew6@jhmi.edu. 2. Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. lmathew6@jhmi.edu. 3. Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 4. Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 5. Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. 6. Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA. 7. Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. 8. Johns Hopkins Center for Health Equity, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 9. Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street Blalock 524D, Baltimore, MD, 21287, USA. 10. Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Abstract
BACKGROUND: Racial disparities in guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) have not been fully documented in a community setting. METHODS: In the ARIC Surveillance Study (2005-2014), we examined racial differences in GDMT at discharge, its temporal trends, and the prognostic impact among individuals with hospitalized HFrEF, using weighted regression models to account for sampling design. Optimal GDMT was defined as beta blockers (BB), mineralocorticoid receptor antagonist (MRA) and ACE inhibitors (ACEI) or angiotensin II receptor blockers (ARB). Acceptable GDMT included either one of BB, MRA, ACEI/ARB or hydralazine plus nitrates (H-N). RESULTS: Of 16,455 (unweighted n = 3,669) HFrEF cases, 47% were Black. Only ~ 10% were discharged with optimal GDMT with higher proportion in Black than White individuals (11.1% vs. 8.6%, p < 0.001). BB use was > 80% in both racial groups while Black individuals were more likely to receive ACEI/ARB (62.0% vs. 54.6%) and MRA (18.0% vs. 13.8%) than Whites, with a similar pattern for H-N (21.8% vs. 10.1%). There was a trend of decreasing use of optimal GDMT in both groups, with significant decline of ACEI/ARB use in Whites (- 2.8% p < 0.01) but increasing H-N use in both groups (+ 6.5% and + 9.2%, p < 0.01). Only ACEI/ARB and BB were associated with lower 1-year mortality. CONCLUSIONS: Optimal GDMT was prescribed in only ~ 10% of HFrEF patients at discharge but was more so in Black than White individuals. ACEI/ARB use declined in Whites while H-N use increased in both races. GDMT utilization, particularly ACEI/ARB, should be improved in Black and Whites individuals with HFrEF.
BACKGROUND: Racial disparities in guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) have not been fully documented in a community setting. METHODS: In the ARIC Surveillance Study (2005-2014), we examined racial differences in GDMT at discharge, its temporal trends, and the prognostic impact among individuals with hospitalized HFrEF, using weighted regression models to account for sampling design. Optimal GDMT was defined as beta blockers (BB), mineralocorticoid receptor antagonist (MRA) and ACE inhibitors (ACEI) or angiotensin II receptor blockers (ARB). Acceptable GDMT included either one of BB, MRA, ACEI/ARB or hydralazine plus nitrates (H-N). RESULTS: Of 16,455 (unweighted n = 3,669) HFrEF cases, 47% were Black. Only ~ 10% were discharged with optimal GDMT with higher proportion in Black than White individuals (11.1% vs. 8.6%, p < 0.001). BB use was > 80% in both racial groups while Black individuals were more likely to receive ACEI/ARB (62.0% vs. 54.6%) and MRA (18.0% vs. 13.8%) than Whites, with a similar pattern for H-N (21.8% vs. 10.1%). There was a trend of decreasing use of optimal GDMT in both groups, with significant decline of ACEI/ARB use in Whites (- 2.8% p < 0.01) but increasing H-N use in both groups (+ 6.5% and + 9.2%, p < 0.01). Only ACEI/ARB and BB were associated with lower 1-year mortality. CONCLUSIONS: Optimal GDMT was prescribed in only ~ 10% of HFrEF patients at discharge but was more so in Black than White individuals. ACEI/ARB use declined in Whites while H-N use increased in both races. GDMT utilization, particularly ACEI/ARB, should be improved in Black and Whites individuals with HFrEF.
Authors: Anne L Taylor; Susan Ziesche; Clyde Yancy; Peter Carson; Ralph D'Agostino; Keith Ferdinand; Malcolm Taylor; Kirkwood Adams; Michael Sabolinski; Manuel Worcel; Jay N Cohn Journal: N Engl J Med Date: 2004-11-08 Impact factor: 91.245
Authors: Stephen J Greene; Javed Butler; Nancy M Albert; Adam D DeVore; Puza P Sharma; Carol I Duffy; C Larry Hill; Kevin McCague; Xiaojuan Mi; J Herbert Patterson; John A Spertus; Laine Thomas; Fredonia B Williams; Adrian F Hernandez; Gregg C Fonarow Journal: J Am Coll Cardiol Date: 2018-07-24 Impact factor: 24.094
Authors: Gregg C Fonarow; Nancy M Albert; Anne B Curtis; Wendy Gattis Stough; Mihai Gheorghiade; J Thomas Heywood; Mark L McBride; Patches Johnson Inge; Mandeep R Mehra; Christopher M O'Connor; Dwight Reynolds; Mary Norine Walsh; Clyde W Yancy Journal: Circulation Date: 2010-07-26 Impact factor: 29.690
Authors: Andrew N Rassi; Matthew A Cavender; Gregg C Fonarow; Christopher P Cannon; Adrian F Hernandez; Eric D Peterson; W Frank Peacock; Warren K Laskey; Sylvia E Rosas; Xin Zhao; Lee H Schwamm; Deepak L Bhatt Journal: J Am Coll Cardiol Date: 2012-11-05 Impact factor: 24.094