Author + information
- Michel White,
- Kanan Patel,
- Guillem Caldentey,
- Prakash Deedwania,
- Inmaculada Aban,
- Alexander Lo,
- Stefan D. Anker and
- Ali Ahmed
In the Beta-Blocker Evaluation of Survival Trial (BEST), bucindolol significantly reduced mortality among whites but had no effect on African Americans (p for interaction, 0.02) with systolic heart failure (HF). Whether this may in part be due to racial differences in baseline characteristics has not been previously examined.
Of the 2,708 BEST patients with chronic advanced systolic HF randomized to receive bucindolol (n=1,354) or placebo (n=1,354), 627 were African American.
African American HF patients were younger (56 vs. 62 years; p <0.001) and more women (29% vs. 19%; p <0.001), which in part explained the non-significant unadjusted hazard ratio (HR) for all-cause mortality for African Americans (HR, 1.10; 95% CI, 0.94-1.29; p=0.228), which became significant (HR, 1.27; 95% CI, 1.08-1.50; p=0.003) when adjusted for age and sex. This association remained significant after multivariable-adjustment including left ventricular ejection fraction (HR, 1.20; 95% CI, 1.01-1.43; p=0.043; Table). However, this association lost significance when right ventricular ejection fraction (RVEF) was added into the full model (HR, 1.17; 95% CI, 0.98-1.39; p=0.089) or the age-sex-adjusted model (HR, 1.15; 95% CI, 0.98-1.36; p=0.093; Table).
African Americans with advanced systolic HF in BEST had higher risk of death, which was in part due to their lower RVEF, which may in part also explain the lack of mortality benefit among African Americans in BEST (JACC.2011;57: E298).
|Hazard ratio (95%CI)||P value|
|Model 1: unadjusted||1.10 (0.94–1.29)||0.228|
|Model 2: model 1 + age, sex||1.27 (1.08–1.50)||0.003|
|Model 3: model 2 + medical historya||1.35 (1.14–1.60)||0.001|
|Model 4: model 3 + medicationsb||1.29 (1.09–1.53)||0.003|
|Model 5: model 4 + clinical/laboratoryc||1.20 (1.01–1.43)||0.043|
|Model 6: model 5 + RVEF||1.17 (0.98–1.39)||0.089|
|Model 7: age + sex + RVEFd||1.15 (0.98–1.36)||0.093|
aSmoking years, duration of HF, NYHA class, acute myocardial infarction, diabetes, hypertension, atrial fibrillation, ventricular fibrillation, peripheral vascular disease, chronic kidney disease.
bBucindolol, ACE inhibitor, ARB, digitalis, diuretics.
cBody mass index, heart rate, systolic and diastolic blood pressure, serum sodium, potassium and albumin, and left ventricular ejection fraction.
dAfrican Americans had lower mean RVEF (32% vs 36%; p <0.001).
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: 1221-287
- 2013 American College of Cardiology Foundation