Outcome in African Americans and other minorities in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT).
BACKGROUND
The SCD-HeFT demonstrated that implantable cardioverter/defibrillator (ICD) therapy significantly improved survival compared to medical therapy alone in stable moderately symptomatic heart failure patients with an ejection fraction < or = 35%. The purpose of this report is to describe the outcomes in African Americans (AAs) and other minorities.


METHODS
Of 2521 patients enrolled, 23% were minorities and 17% were AAs. Baseline demographic, clinical variables, socioeconomic status, and long-term outcomes were compared according to race. Two major prespecified subgroups were examined: heart failure cause (ischemic vs nonischemic) and New York Heart Association class (II vs III).


RESULTS
At baseline, compared to whites, AAs were younger and had more nonischemic heart failure, lower ejection fractions, worse New York Heart Association functional class, and higher prevalence of a history of nonsustained ventricular tachycardia. Comparable percentages of whites and AAs held paid jobs, but whites had a significantly higher educational level and household income (P = .001). Compliance with ICD implantation and medical therapy was comparable in both subgroups. No significant difference was observed in the rate of ICD discharge among whites and AAs. Adjusted mortality risk was significantly higher in AAs compared to whites (hazard ratio 1.27, P = .038). Mortality was equally reduced in both race groups receiving ICD therapy compared to placebo (hazard ratio 0.65 in AAs and 0.73 in whites).


CONCLUSIONS
Survival benefits from ICD therapy in SCD-HeFT were not dependent on race. In addition, in this clinical trial setting, there was no evidence that AAs were less willing to accept ICD therapy than whites.
Mitchell
Judith E
JE
State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA. jemitchell@pol.net
Hellkamp
Anne S
AS
Mark
Daniel B
DB
Anderson
Jill
J
Poole
Jeanne E
JE
Lee
Kerry L
KL
Bardy
Gust H
GH
D001741:Black or African American; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000208:ethnology* / Q000209:etiology / Q000517:prevention & control; D004554:Electric Countershock / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000208:ethnology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone