title: Use of hydralazine-isosorbide dinitrate combination in African American and other race/ethnic group patients with heart failure and reduced left ventricular ejection fraction.
abstract: BACKGROUND
  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 therapy in clinical practice are unknown.
  
  
  RESULTS
  An observational analysis of 54 622 patients admitted with HFrEF and discharged home from 207 hospitals participating in the Get With The Guidelines-Heart Failure registry from April 2008 to March 2012 was conducted to assess prescription, trends, and predictors of use of H-ISDN among eligible patients. Among 11 185 African American patients eligible for H-ISDN therapy, only 2500 (22.4%) received H-ISDN therapy at discharge. In the overall eligible population, 5115 of 43 498 (12.6%) received H-ISDN at discharge. Treatment rates increased over the study period from 16% to 24% among African Americans and from 10% to 13% among the entire HFrEF population. In a multivariable model, factors associated with H-ISDN use among the entire cohort included younger age; male sex; African American/Hispanic ethnicity; and history of diabetes, hypertension, anemia, renal insufficiency, higher systolic blood pressure, and lower heart rate. In African American patients, these factors were similar; in addition, being uninsured was associated with lower use.
  
  
  CONCLUSIONS
  Overall, few potentially eligible patients with HFrEF are treated with H-ISDN, and among African-Americans fewer 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.
authors: Oklahoma University Health Science Center, VA Medical Center, Oklahoma City, OK.
authors: Harsh B
authors: HB
authors: Golwala
authors: Udho
authors: U
authors: Thadani
authors: Li
authors: L
authors: Liang
authors: Stavros
authors: S
authors: Stavrakis
authors: Javed
authors: J
authors: Butler
authors: Clyde W
authors: CW
authors: Yancy
authors: Deepak L
authors: DL
authors: Bhatt
authors: Adrian F
authors: AF
authors: Hernandez
authors: Gregg C
authors: GC
authors: Fonarow
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004338:Drug Combinations; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence; D054625:Healthcare Disparities / Q000208:ethnology* / Q000639:trends; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D006801:Humans; D006830:Hydralazine / Q000009:adverse effects / Q000627:therapeutic use*; D007548:Isosorbide Dinitrate / Q000009:adverse effects / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends; D011446:Prospective Studies; D012042:Registries; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016277:Ventricular Function, Left
chemical_list: D004338:Drug Combinations; D014665:Vasodilator Agents; C431665:isosorbide-hydralazine combination; D006830:Hydralazine; D007548:Isosorbide Dinitrate
keywords: guideline adherence; heart failure; quality; race/ethnicity; registry
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