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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 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-HF registry from 2008 to 2012 was conducted. Among 11,185 African American patients eligible for H-ISDN therapy, only 2,500 (22.4%) received H-ISDN therapy at discharge. In the overall eligible population, 5,115 of 43,498 (12.6%) received H-ISDN at discharge. Trends in use are shown in figurebelow. In a multivariable model, factors associated with use of H-ISDN included younger age, male gender, African American race and Hispanic ethnicity, history of diabetes, hypertension, peripheral vascular disease, stroke, anemia, renal insufficiency, absence of smoking, higher systolic blood pressure, and lower heart rate. Hospital variables associated with H-ISDN use included hospitals with higher bed count.
Overall, few potentially eligible patients with HFrEF are treated with H-ISDN and among African-Americans less 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.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Novel and Standard Pharmacological Therapies in Heart Failure: Which Treatment for Which Patient
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1221-286
- 2013 American College of Cardiology Foundation