Abstract 12682: Angiotensin-Converting Enzyme Inhibitors have a Distinct Effect on Hispanic Patients Compared to African-Americans and Whites With Heart Failure and Reduced Left Ventricular Ejection Fraction
Introduction: There is currently no data regarding the efficacy of angiotensin-converting enzyme inhibitors (ACEi) in Hispanic patients with heart failure (HF). We hypothesized that ACEi have a distinct effect on Hispanic patients compared to non-Hispanic White and non-Hispanic African-American patients with systolic HF.
Methods: From Montefiore Medical Center’s Clinical Information System, 618 consecutive patients with systolic HF (LVEF ≤ 35%) who were on a beta-blocker were retrospectively identified. Patients’ self-identified race/ethnicity were categorized into 3 groups: African-Americans, Hispanics, and Whites/Caucasians. Each group was divided into 2 sub-groups based on whether or not they were on an ACEi for 12 consecutive months. Primary endpoint was 1-year all-cause mortality; secondary endpoint was 1-year readmission for HF exacerbation.
Results: Of 618 patients, 66% were categorized as ACEi group and 34% as No-ACEi group. Overall, 1-year mortality was significantly different between ACEi and No-ACEi groups (7.2 vs 12.9%, RR 1.84 [95% CI 1.08-3.17], p=0.02) while readmission rate was not different (2.1 vs 2.8%, RR 1.24 [95% CI 0.45-3.42], p=0.6). After stratifying patients based on race/ethnicity, ACEi group demonstrated a lower 1-year mortality compared to No-ACEi group in Hispanics (4.4 vs 21.0%, RR 5.20 [95% CI 2.02-13.41], p≤0.001) but not in African-Americans (11.1 vs 9.4%, RR 0.85 [95% CI 0.31-2.38], p=0.8) or Whites (6.1 vs 8.6%, RR 1.40 [95% CI 0.49-4.04], p=0.52). One-year readmission was not different between ACEi and No-ACEi groups in total population, Hispanics, African-Americans, or Whites (all p=NS). Using univariate and multivariate analysis adjusted for baseline characteristics, there was a significant interaction between ACEi and Hispanic race regarding the 1-year mortality (HR 0.21 [SE 0.61], p=0.01).
Conclusions: ACEi therapy has a distinct effect on Hispanic patients with systolic HF by reducing 1-year mortality.
- © 2013 by American Heart Association, Inc.