title: Mortality in African-Americans Following Cardiac Resynchronization Therapy: A Single Center Experience.
abstract: Cardiac resynchronization therapy (CRT) improves clinical outcomes and reduces mortality in heart failure patients who remain symptomatic despite optimal medical therapy. CRT trials have reported significant hemodynamic benefits, improvement in functional status, and reduced mortality and heart failure hospitalizations. However, African-American patient representation in these studies is limited thus the results may not be applicable to them. We described baseline clinical characteristics of African-American patients undergoing CRT and determined their outcomes relative to those reported in clinical trials.
  
  
  
  We evaluated 131 African-American patients with New York Heart Association functional class II-IV heart failure undergoing CRT and determined predictors of all-cause mortality. Kaplan-Meier survival estimates and a Cox proportional hazards model determined mortality and risk of death.
  
  
  
  The mean age was 65 ± 12 years. Over a 6-year period, total mortality in African-Americans was 23% as compared with 29% in the MADIT-CRT trial. Increased mortality was associated with older age (hazard rate (HR) 1.04, 95% confidence interval (CI) 1.01-1.07, P=.01), ischemic cardiomyopathy (HR 2.86, 95% CI 1.36-6.04, P=.006), and absence of treatment with either an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (HR 2.75, 95% CI 1.30-5.80, P=.008), or beta-blocker (HR 2.56, 95% CI 0.98-6.69, P=.05). Hydralazine plus nitrate therapy was used in a small number of patients and did not influence mortality outcomes.
  
  
  
  African-Americans experience the same survival benefits from CRT as Caucasian patients reported in major clinical trials. Publication indices used to find publications listed in references: PubMed.
authors.affiliation: Division of Cardiology, Electrophysiology Section, Drexel University College of Medicine. Electronic address: john.fontaine@drexelmed.edu.
authors.forename: John M
authors.initials: JM
authors.lastname: Fontaine
authors.affiliation: Division of Cardiology, Electrophysiology Section, Drexel University College of Medicine.
authors.forename: Sona M
authors.initials: SM
authors.lastname: Franklin
authors.affiliation: Division of Cardiology, Electrophysiology Section, Drexel University College of Medicine.
authors.forename: Ashwani
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Division of Cardiology, Electrophysiology Section, Drexel University College of Medicine.
authors.forename: Christina U
authors.initials: CU
authors.lastname: Kang
mesh_terms: D001741:Black or African American; D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000208:ethnology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
keywords: African-Americans; Cardiac resynchronization therapy; congestive heart failure; implantable cardioverter-defibrillator