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Racial Differences in Trends and Prognosis of Guideline-Directed Medical Therapy for Heart Failure with Reduced Ejection Fraction: the Atherosclerosis Risk in Communities (ARIC) Surveillance Study.
Mathews, Lena; Ding, Ning; Sang, Yingying; Loehr, Laura R; Shin, Jung-Im; Punjabi, Naresh M; Bertoni, Alain G; Crews, Deidra C; Rosamond, Wayne D; Coresh, Josef; Ndumele, Chiadi E; Matsushita, Kunihiro; Chang, Patricia P.
Afiliación
  • Mathews L; Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street Blalock 524D, Baltimore, MD, 21287, USA. lmathew6@jhmi.edu.
  • Ding N; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. lmathew6@jhmi.edu.
  • Sang Y; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Loehr LR; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Shin JI; Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  • Punjabi NM; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Bertoni AG; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Crews DC; Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Rosamond WD; Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
  • Coresh J; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Ndumele CE; Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Matsushita K; Johns Hopkins Center for Health Equity, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Chang PP; Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Racial Ethn Health Disparities ; 10(1): 118-129, 2023 02.
Article en En | MEDLINE | ID: mdl-35001343
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Inhibidores de la Enzima Convertidora de Angiotensina / Insuficiencia Cardíaca Tipo de estudio: Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies / Screening_studies Aspecto: Equity_inequality Límite: Humans Idioma: En Revista: J Racial Ethn Health Disparities Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Suiza
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Inhibidores de la Enzima Convertidora de Angiotensina / Insuficiencia Cardíaca Tipo de estudio: Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies / Screening_studies Aspecto: Equity_inequality Límite: Humans Idioma: En Revista: J Racial Ethn Health Disparities Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Suiza