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Clinical Effectiveness of CRT and ICD Therapy in Heart Failure Patients by Racial/Ethnic Classification

Journal of the American College of Cardiology, 2014-08, Vol.64 (8), p.797-807 [Peer Reviewed Journal]

American College of Cardiology Foundation ;2014 American College of Cardiology Foundation ;Copyright Elsevier Limited Aug 26, 2014 ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2014.05.060

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  • Title:
    Clinical Effectiveness of CRT and ICD Therapy in Heart Failure Patients by Racial/Ethnic Classification
  • Author: Ziaeian, Boback, MD ; Zhang, Yan, MS ; Albert, Nancy M., PhD, RN ; Curtis, Anne B., MD ; Gheorghiade, Mihai, MD ; Heywood, J. Thomas, MD ; Mehra, Mandeep R., MD ; O’Connor, Christopher M., MD ; Reynolds, Dwight, MD ; Walsh, Mary Norine, MD ; Yancy, Clyde W., MD ; Fonarow, Gregg C., MD
  • Subjects: African Americans ; cardiac resynchronization therapy ; Cardiovascular ; clinical effectiveness ; Clinical medicine ; Clinical trials ; Confidence intervals ; Drug therapy ; Ethnicity ; Heart attacks ; Heart failure ; Hispanic Americans ; Internal Medicine ; Mortality ; Race ; race/ethnicity ; Ratios
  • Is Part Of: Journal of the American College of Cardiology, 2014-08, Vol.64 (8), p.797-807
  • Description: 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. Objectives 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.
  • Publisher: New York: Elsevier Inc
  • Language: English
  • Identifier: ISSN: 0735-1097
    EISSN: 1558-3597
    DOI: 10.1016/j.jacc.2014.05.060
  • Source: Geneva Foundation Free Medical Journals at publisher websites
    Alma/SFX Local Collection
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