title: Clinical Effectiveness of Hydralazine-Isosorbide Dinitrate Therapy in Patients With Heart Failure and Reduced Ejection Fraction: Findings From the Get With The Guidelines-Heart Failure Registry.
abstract: BACKGROUND
  In clinical trials, hydralazine-isosorbide dinitrate (H-ISDN) for heart failure with reduced ejection fraction reduced morbidity and mortality among black patients and patients with intolerance to angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. The effectiveness of H-ISDN in clinical practice is unknown.
  
  
  RESULTS
  Using data from a clinical registry linked with Medicare claims, we examined the use and outcomes of H-ISDN between 2005 and 2011 among older patients hospitalized with heart failure and reduced ejection fraction. We adjusted for demographic and clinical characteristics using Cox proportional hazards models and inverse probability weighting. Among 4663 eligible patients, 22.7% of black patients and 18.2% of patients not on an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker were newly prescribed H-ISDN therapy at discharge. By 3 years, the cumulative incidence rates of mortality and readmission were similar between treated and untreated patients. After multivariable adjustment, 3-year outcomes remained similar for mortality [black patients: hazard ratio (HR), 0.92; 95% confidence interval (CI), 0.75-1.13; other patients: HR, 0.93; 95% CI, 0.79-1.09], all-cause readmission (black patients: HR, 0.98; 95% CI, 0.84-1.13; other patients: HR, 1.02; 95% CI, 0.90-1.17), and cardiovascular readmission (black patients: HR, 0.99; 95% CI, 0.82-1.19; other patients: HR, 0.94; 95% CI, 0.81-1.09). A post hoc analysis of Medicare Part D data revealed low postdischarge adherence to therapy.
  
  
  CONCLUSIONS
  Guideline-recommended initiation of H-ISDN therapy at hospital discharge was uncommon, and adherence was low. For both black patients and patients of other races, there were no differences in outcomes between those treated and untreated at discharge.
authors: From the Duke Clinical Research Institute (P.K., L.L., L.H.C., Z.J.E., E.D.P., A.F.H.) and Department of Medicine (P.K., L.H.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Department of Medicine, Emory University, Atlanta, GA (J.B.); VA Palo Alto Healthcare System, CA (P.A.H.); Heart and Vascular Center and Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors: Prateeti
authors: P
authors: Khazanie
authors: From the Duke Clinical Research Institute (P.K., L.L., L.H.C., Z.J.E., E.D.P., A.F.H.) and Department of Medicine (P.K., L.H.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Department of Medicine, Emory University, Atlanta, GA (J.B.); VA Palo Alto Healthcare System, CA (P.A.H.); Heart and Vascular Center and Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors: Li
authors: L
authors: Liang
authors: From the Duke Clinical Research Institute (P.K., L.L., L.H.C., Z.J.E., E.D.P., A.F.H.) and Department of Medicine (P.K., L.H.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Department of Medicine, Emory University, Atlanta, GA (J.B.); VA Palo Alto Healthcare System, CA (P.A.H.); Heart and Vascular Center and Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors: Lesley H
authors: LH
authors: Curtis
authors: From the Duke Clinical Research Institute (P.K., L.L., L.H.C., Z.J.E., E.D.P., A.F.H.) and Department of Medicine (P.K., L.H.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Department of Medicine, Emory University, Atlanta, GA (J.B.); VA Palo Alto Healthcare System, CA (P.A.H.); Heart and Vascular Center and Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors: Javed
authors: J
authors: Butler
authors: From the Duke Clinical Research Institute (P.K., L.L., L.H.C., Z.J.E., E.D.P., A.F.H.) and Department of Medicine (P.K., L.H.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Department of Medicine, Emory University, Atlanta, GA (J.B.); VA Palo Alto Healthcare System, CA (P.A.H.); Heart and Vascular Center and Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors: Zubin J
authors: ZJ
authors: Eapen
authors: From the Duke Clinical Research Institute (P.K., L.L., L.H.C., Z.J.E., E.D.P., A.F.H.) and Department of Medicine (P.K., L.H.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Department of Medicine, Emory University, Atlanta, GA (J.B.); VA Palo Alto Healthcare System, CA (P.A.H.); Heart and Vascular Center and Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors: Paul A
authors: PA
authors: Heidenreich
authors: From the Duke Clinical Research Institute (P.K., L.L., L.H.C., Z.J.E., E.D.P., A.F.H.) and Department of Medicine (P.K., L.H.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Department of Medicine, Emory University, Atlanta, GA (J.B.); VA Palo Alto Healthcare System, CA (P.A.H.); Heart and Vascular Center and Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors: Deepak L
authors: DL
authors: Bhatt
authors: From the Duke Clinical Research Institute (P.K., L.L., L.H.C., Z.J.E., E.D.P., A.F.H.) and Department of Medicine (P.K., L.H.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Department of Medicine, Emory University, Atlanta, GA (J.B.); VA Palo Alto Healthcare System, CA (P.A.H.); Heart and Vascular Center and Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors: Eric D
authors: ED
authors: Peterson
authors: From the Duke Clinical Research Institute (P.K., L.L., L.H.C., Z.J.E., E.D.P., A.F.H.) and Department of Medicine (P.K., L.H.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Department of Medicine, Emory University, Atlanta, GA (J.B.); VA Palo Alto Healthcare System, CA (P.A.H.); Heart and Vascular Center and Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors: Clyde W
authors: CW
authors: Yancy
authors: From the Duke Clinical Research Institute (P.K., L.L., L.H.C., Z.J.E., E.D.P., A.F.H.) and Department of Medicine (P.K., L.H.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Department of Medicine, Emory University, Atlanta, GA (J.B.); VA Palo Alto Healthcare System, CA (P.A.H.); Heart and Vascular Center and Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.).
authors: Gregg C
authors: GC
authors: Fonarow
authors: From the Duke Clinical Research Institute (P.K., L.L., L.H.C., Z.J.E., E.D.P., A.F.H.) and Department of Medicine (P.K., L.H.C., Z.J.E., E.D.P., A.F.H.), Duke University School of Medicine, Durham, NC; Department of Medicine, Emory University, Atlanta, GA (J.B.); VA Palo Alto Healthcare System, CA (P.A.H.); Heart and Vascular Center and Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.). adrian.hernandez@duke.edu.
authors: Adrian F
authors: AF
authors: Hernandez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D018450:Disease Progression; D004338:Drug Combinations; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D006830:Hydralazine / Q000009:adverse effects / Q000627:therapeutic use*; D007548:Isosorbide Dinitrate / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D054524:Medicare Part D; D010351:Patient Discharge; D010359:Patient Readmission; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D004338:Drug Combinations; C431665:isosorbide-hydralazine combination; D006830:Hydralazine; D007548:Isosorbide Dinitrate
keywords: cardiomyopathies; heart failure; mortality; pharmacology; registries; survival