Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been established as a mainstay of heart failure treatment. Current data are limited and conflicting regarding the consistency of ACE/ARB benefit across race groups in heart failure. This study aims to clarify this point.
This was a retrospective study of insured patients with a documented ejection fraction of less than 50%, hospitalized for heart failure between January 2000 and June 2008. Pharmacy claims data were used to estimate ACE/ARB exposure over 6-month rolling windows. The association between ACE/ARB exposure and all-cause hospitalization or death was assessed by proportional hazards regression, with adjustment for baseline covariates and β-blocker exposure. Further analyses were stratified by race, and included an ACE/ARB × Race interaction term.
A total of 1095 patients met inclusion criteria (619 African-American individuals). Median follow-up was 2.1 years. In adjusted models, ACE/ARB exposure was associated with lower risk of death or hospitalization in both groups (African-Americans hazard ratio 0.47, P < 0.001; whites hazard ratio 0.55, P < 0.001). A formal test for interaction was consistent with similar effects in each group (P = 0.861, β = 0.04).
ACE/ARB exposure was equally associated with a protective effect in preventing death or rehospitalization among heart failure patients with systolic dysfunction in both African-American patients and whites.
aDepartment of Internal Medicine
bHeart and Vascular Institute
cDepartment of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
dMid America Heart Institute, Kansas City, Missouri
eCenter for Health Services Research, Henry Ford Hospital, Detroit, Michigan, USA
Correspondence to David E. Lanfear, Henry Ford Hospital, 2799 W. Grand Blvd., K14, Detroit, MI 48202, USA Tel: +1 313 916 6375; fax: +1 313 916 8799; e-mail: email@example.com
Received 14 October, 2013
Revised 26 February, 2014
Accepted 26 February, 2014