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Angiotensin converting enzyme inhibitors and beta-blockers in African Americans with heart failure

Peter A McCullough1, Edward F Philbin, John A Spertus

  • 1Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, Beaumont Health Center, Royal Oak, MI 48073, USA. pmc975@yahoo.com

Ethnicity & Disease
|August 5, 2003
PubMed

Insights

African Americans with congestive heart failure (CHF) benefit from early treatment with angiotensin converting enzyme inhibitors (ACEI) and beta-blockers (BB). Prompt initiation of these medications within the first year of CHF diagnosis improved survival rates in this population.

Area of Science:

  • Cardiology
  • Pharmacology
  • Health Disparities

Background:

  • Previous studies suggested reduced efficacy of ACEI and variable efficacy of BB in African Americans (AA) with CHF.
  • Potential lead-time bias in prior analyses may have influenced findings, with AA potentially enrolled later in their disease course.
  • Understanding early treatment benefits for AA with CHF is crucial for addressing health disparities.

Purpose of the Study:

  • To prospectively evaluate the impact of early administration of ACEI and BB on mortality in African Americans with CHF.
  • To examine medication use patterns and their association with survival outcomes in a diverse CHF cohort.
  • To mitigate potential lead-time bias by focusing on treatment initiated within the first year of CHF diagnosis.

Main Methods:

  • Prospective cohort study of 29,686 CHF patients within a single health system (1995-1998).
  • Pharmacy claims data analyzed for 3353 newly diagnosed CHF patients, including 39.2% African Americans.
  • Comparison of ACEI and BB utilization rates and relative risk reductions (RRR) for mortality across racial groups.

Main Results:

  • ACEI use showed significant RRR for Whites (68.7%) and AA (52.1%), but not for other races (-36.3%).
  • BB use demonstrated significant RRR for Whites (59.0%) and AA (34.6%), with a non-significant trend for other races (74.3%).
  • Age- and gender-adjusted survival rates for AA were significantly enhanced with ACEI (P<.001), BB (P=.001), or combination therapy (P=.003).

Conclusions:

  • Early initiation of ACEI and BB within the first year of CHF diagnosis is associated with improved survival in African Americans.
  • Findings suggest that AA populations benefit from these guideline-directed medical therapies when administered promptly.
  • Future research should control for illness duration to prevent lead-time bias in studies of AA with CHF.

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