title: Effect of fixed-dose combined isosorbide dinitrate/hydralazine in elderly patients in the African-American heart failure trial.
abstract: BACKGROUND
  Fixed-dose combined isosorbide dinitrate/hydralazine (FDC I/H) significantly improved outcomes in patients with advanced heart failure (HF) receiving background neurohormonal therapy in the African-American Heart Failure Trial (A-HeFT). In this analysis, we investigated treatment effects by age <65 or ≥65 years.
  
  
  RESULTS
  Time-to-event curves were produced by the Kaplan-Meier method. Hazard ratios were calculated with the Cox proportional hazards model. Baseline characteristics showed that patients ≥65 years old had less hypertensive and more ischemic HF, better quality of life (QoL) scores, higher plasma B-type natriuretic peptide and creatinine levels, and received less background neurohormonal therapy. Kaplan-Meier curves showed that FDC I/H improved mortality and event-free survival in elderly patients. The hazard ratios for mortality, first heart failure hospitalization, and event-free survival (both unadjusted and adjusted for baseline differences), were similar quantitatively and in direction of effect in both age groups.
  
  
  CONCLUSIONS
  In A-HeFT, FDC I/H improved outcomes in HF patients aged <65 or ≥65 years, despite significant baseline differences between these age groups. Patients aged ≥65 years, a group at greater mortality risk, had the greatest survival benefit from FDC I/H.
authors.affiliation: Department of Medicine, Columbia University Medical Center, College of Physicians and Surgeons, New York, New York 10032, USA. ataylor@columbia.edu
authors.forename: Anne L
authors.initials: AL
authors.lastname: Taylor
authors.forename: Michael L
authors.initials: ML
authors.lastname: Sabolinski
authors.forename: S William
authors.initials: SW
authors.lastname: Tam
authors.forename: Susan
authors.initials: S
authors.lastname: Ziesche
authors.forename: Jalal K
authors.initials: JK
authors.lastname: Ghali
authors.forename: W Tad
authors.initials: WT
authors.lastname: Archambault
authors.forename: Manuel
authors.initials: M
authors.lastname: Worcel
authors.forename: Jay N
authors.initials: JN
authors.lastname: Cohn
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000375:Aging; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D006830:Hydralazine / Q000627:therapeutic use*; D007548:Isosorbide Dinitrate / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020030:Nitric Oxide Donors / Q000627:therapeutic use*; D011788:Quality of Life / Q000523:psychology; D013995:Time; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D020030:Nitric Oxide Donors; D014665:Vasodilator Agents; D006830:Hydralazine; D007548:Isosorbide Dinitrate