Abstract 2642: Ventricular Tachycardia in the African-American Heart Failure Trial
Introduction: The objectives of this study were to evaluate the incidence of ventricular tachycardia (VT) in the African-American Heart Failure Trial (A-HeFT) and the effect of a fixed-dose combination of isosorbide dinitrate and hydralazine (FDC I/H) in patients (pts) with a documented history of VT.
Method: Data from A-HeFT, a study of 1050 African American (AA) pts with NYHA Class III-IV heart failure (HF) treated with contemporary HF medicines (87% on beta-blockers, 93% on ACEI and/or ARB, and 39% on spironolactone) were analyzed. Kaplan-Meier survival analyses were used for outcome analysis. To avoid the influence of atrial fibrillation (AF), pts with both VT and AF (n=61) were excluded in the analysis.
Results: At baseline, a history of VT was documented in 179 pts - sustained VT in 30% and non-sustained VT in 70%. During the trial no significant difference was found in the incidence of VT in these pts randomized to FDC I/H or placebo (2.2% vs. 4.4%, p=0.68). Likewise, in the full A-HeFT cohort, no significant difference in the incidence of VT by treatment assignment (4.1% for FDC I/H vs. 2.7% for placebo, p=0.23) was observed. Comparing pts with VT to those without VT, we found that at baseline VT pts had significantly lower systolic BP, diastolic BP, ejection fraction, and a larger LVIDD, and higher usage of spironolactone, digitalis, and anti-arrhythmia drugs. A confirmed history of VT or VT occurring during the trial increased the risk of mortality or HF hospitalization (HR=1.68, p<0.001) and impacted primarily males (HR=2.31, p=0.0006, n=117) [females (HR=0.92, p=0.78, n=74)]. In addition, pts with VT were more frequently hospitalized for any cause (p<0.0001) and readmitted for any cause (p<0.0001) or for HF (p<0.001). In pts with VT, FDC I/H (n=96) added to standard HF therapy demonstrated a strong trend in reducing the risk of mortality (HR=0.38, p=0.054) and mortality or HF hospitalization (HR=0.61, p=0.059) compared to VT pts on standard therapy alone (n=95).
Conclusions: FDC I/H was not associated with an increased risk for VT. VT at baseline or during follow up in AA pts with HF is associated with increased mortality or hospitalization primarily in males. Addition of FDC I/H to standard medications for HF reduced this increased risk.