Abstract 2738: Impact of Fixed-Dose Combination of Isosorbide Dinitrate and Hydralazine on Heart Failure Progression in an African American Population: Focus on Mode of Death and Hospitalization
Introduction: Limited data exist on mode of death and cause of hospitalization in African American (AA) heart failure (HF) patients. A-HeFT is the only prospective study in this patient population.
Methods: The mode of death and cause of hospitalization were explored in A-HeFT, a randomized double-blind placebo-controlled study in 1,050 AA patients. Due to the competing risk for hospitalization and death, event-free survival was also analyzed. The causes of death and hospitalization were adjudicated by an Independent Central Adjudication Committee.
Results: There were a total of 86 deaths in A-HeFT. The most frequent cause of death was cardiac death (73%), which was significantly improved by the fixed dose combination of isosorbide dinitrate/hydralazine (I/H) (p=0.009). The treatment effect of I/H on pump failure death (73% reduction) and overall cardiac deaths is shown in the table⇓ below. There were a total of 994 hospitalizations reported in A-HeFT. The number of HF hospitalizations was decreased by 31% with I/H. First hospitalization for HF or all-cause mortality was significantly reduced in the I/H group (37%, p<0.001). First hospitalization for any cause or all-cause mortality favored the I/H group (14% reduction, p=0.115).
Conclusion: In AA patients with NYHA class III and IV HF, most deaths were due to a cardiac cause, most commonly sudden death followed by pump failure death. I/H principally decreased cardiac mortality by decreasing pump failure deaths. This finding, combined with the marked reduction in HF hospitalizations suggests an influence on the progression of heart failure.