title: Clinical effectiveness of CRT and ICD therapy in heart failure patients by racial/ethnic classification: insights from the IMPROVE HF registry.
abstract: BACKGROUND
  Clinical trials have demonstrated benefit for cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) therapies in patients with heart failure with reduced ejection fraction (HFrEF); yet, questions have been raised with regard to the benefit of device therapy for minorities.
  
  
  OBJECTIVE
  The purpose of this study was to determine the clinical effectiveness of CRT and ICD therapies as a function of race/ethnicity in outpatients with HFrEF (ejection fraction ≤35%).
  
  
  METHODS
  Data from IMPROVE HF (Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting) were analyzed by device status and race/ethnicity among guideline-eligible patients for mortality at 24 months. Multivariate Generalized Estimating Equations analyses were conducted, adjusting for patient and practice characteristics.
  
  
  RESULTS
  The ICD/cardiac resynchronization defibrillator (CRT-D)-eligible cohort (n = 7,748) included 3,391 (44%) non-Hispanic white, 719 (9%) non-Hispanic black, and 3,638 (47%) other racial/ethnic minorities or race-not-documented patients. The cardiac resynchronization pacemaker (CRT-P)/CRT-D-eligible cohort (n = 1,188) included 596 (50%) non-Hispanic white, 99 (8%) non-Hispanic black, and 493 (41%) other/not-documented patients. There was clinical benefit associated with ICD/CRT-D therapy (adjusted odds ratio: 0.64, 95% confidence interval: 0.52 to 0.79, p = 0.0002 for 24-month mortality), which was of similar proportion in white, black, and other minority/not-documented patients (device-race/ethnicity interaction p = 0.7861). For CRT-P/CRT-D therapy, there were also associated mortality benefits (adjusted odds ratio: 0.55, 95% confidence interval: 0.33 to 0.91, p = 0.0222), and the device-race/ethnicity interaction was not significant (p = 0.5413).
  
  
  CONCLUSIONS
  The use of guideline-directed CRT and ICD therapy was associated with reduced 24-month mortality without significant interaction by racial/ethnic group. Device therapies should be offered to eligible heart failure patients, without modification based on race/ethnicity.
authors.affiliation: Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, California.
authors.forename: Boback
authors.initials: B
authors.lastname: Ziaeian
authors.affiliation: Medtronic, Inc., Mounds View, Minnesota.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
authors.affiliation: Department of Medicine, University at Buffalo, Buffalo, New York.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Curtis
authors.affiliation: Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.affiliation: Division of Cardiology, Scripps Clinic, La Jolla, California.
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Heywood
authors.affiliation: Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Dwight
authors.initials: D
authors.lastname: Reynolds
authors.affiliation: St. Vincent Heart Center of Indiana, Indianapolis, Indiana.
authors.forename: Mary Norine
authors.initials: MN
authors.lastname: Walsh
authors.affiliation: Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles Medical Center, Los Angeles, California. Electronic address: gfonarow@mednet.ucla.edu.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000706:statistics & numerical data*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D013318:Stroke Volume; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
keywords: cardiac resynchronization therapy; clinical effectiveness; heart failure; mortality; race/ethnicity