Racial differences in mortality in patients with advanced systolic heart failure: potential role of right ventricular ejection fraction.
Pubmed ID: 25499389
Journal: International journal of cardiology
Publication Date: Nov. 15, 2014
MeSH Terms: Humans, Male, Female, United States, Middle Aged, Adrenergic beta-Antagonists, Severity of Illness Index, Incidence, Survival Rate, Stroke Volume, Propanolamines, Heart Failure, Systolic, Ventricular Function, Right, Racial Groups
Grants: R01-HL085561, R01-HL097047, R01-HL085561-S
Authors: White M, Aronow WS, Ahmed A, Anker SD, Fonarow GC, Aban IB, Deedwania P, Patel K, Fletcher RD, Kheirbek R, Caldentey G, Lo A
Cite As: White M, Patel K, Caldentey G, Deedwania P, Kheirbek R, Fletcher RD, Aban IB, Lo A, Aronow WS, Fonarow GC, Anker SD, Ahmed A. Racial differences in mortality in patients with advanced systolic heart failure: potential role of right ventricular ejection fraction. Int J Cardiol 2014 Nov 15;177(1):255-60. Epub 2014 Sep 28.
Studies:
- Beta-Blocker Evaluation in Survival Trial (BEST)
- Systolic Blood Pressure Intervention Trial (SPRINT)
- Systolic Blood Pressure Intervention Trial Primary Outcome Paper (SPRINT-POP) Data
Abstract
In Beta-Blocker Evaluation of Survival Trial (BEST) bucindolol significantly reduced mortality among Caucasians with systolic heart failure (HF) but not among African Americans. Whether this differential effect can be explained by racial differences in baseline characteristics has not been previously examined. Of the 2708 BEST participants, 627 were African Americans. Because African Americans were more likely to be younger and women, we used age-sex-adjusted hazard ratios (HR) and 95% confidence intervals (CI) to estimate their outcomes (vs. Caucasians). A step-wise multivariable-adjusted model using 24 baseline characteristics was used to identify variables associated with between-race outcome differences and propensity-matching was used to determine independence of associations. Age-sex-adjusted HR for all-cause mortality for African Americans during 2 years of mean follow-up was 1.27. African Americans were more likely to have lower right ventricular ejection fraction. African Americans had no association with mortality among propensity-matched patients. The higher risk of death among African Americans in BEST may in part be due to their lower RVEF which may in part explain the lack of response to bucindolol among these patients. Future studies need to examine the role of low RVEF on the effect of beta-blockers in patients with systolic HF.