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Angiotensin Receptor Neprilysin Inhibition and Associated Outcomes by Race and Ethnicity in Patients With Heart
Brittany Chapman1, Anne S Hellkamp2, Laine E Thomas2
1Department of Medicine Duke University School of Medicine Durham NC.
Insights
Angiotensin receptor neprilysin inhibitors (ARNIs) show similar benefits for heart failure (HF) patients across diverse racial and ethnic groups. This study found no significant differences in health status or clinical outcomes when initiating ARNIs, regardless of race or ethnicity.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Health Disparities
Background:
- Limited data exist on Angiotensin Receptor Neprilysin Inhibitor (ARNI) use in minority populations with heart failure (HF) with reduced ejection fraction (HFrEF).
- Understanding treatment efficacy across diverse racial and ethnic groups is crucial for equitable HF management.
- The CHAMP-HF registry provides a valuable dataset for examining ARNI initiation in real-world HFrEF patients.
Purpose of the Study:
- To evaluate ARNI initiation and its impact on health status and clinical outcomes in a diverse HFrEF patient cohort.
- To compare the effectiveness of ARNI therapy across different racial and ethnic groups within the CHAMP-HF registry.
- To determine if race and ethnicity modify the association between ARNI initiation and patient outcomes.
Main Methods:
- Prospective, observational registry (CHAMP-HF) of US outpatients with chronic HFrEF.
- Propensity-matched analysis comparing patients initiating ARNI versus those not initiating ARNI.
- Health status assessed via Kansas City Cardiomyopathy Questionnaire (KCCQ); outcomes analyzed using multivariable models and Cox proportional hazards models.
Main Results:
- No statistically significant interaction was found between race/ethnicity and ARNI initiation for changes in KCCQ scores (P=0.21).
- Similarly, no significant interaction was observed for HF hospitalization (P=0.82) or all-cause mortality (P=0.92).
- ARNI initiation was associated with similar improvements in health status across Hispanic, non-Hispanic Black, non-Hispanic White, and non-Hispanic other individuals.
Conclusions:
- The association between ARNI initiation and clinical outcomes in HFrEF does not differ significantly by race or ethnicity.
- These findings support the use of ARNI therapy for HFrEF irrespective of a patient's racial or ethnic background.
- ARNI therapy demonstrates consistent benefits across diverse populations, promoting equitable heart failure management.
Background:
There are limited data on the use of angiotensin receptor neprilysin inhibitors (ARNIs) in minority populations with heart failure (HF) with reduced ejection fraction. We used data from the CHAMP-HF (Change the Management of Patients With Heart Failure) registry to evaluate ARNI initiation and associated changes in health status and clinical outcomes across different races and ethnicities.
Methods And Results:
CHAMP-HF was a prospective, observational registry of US outpatients with chronic HF with reduced ejection fraction. We compared patients starting ARNI with patients not starting ARNI using a propensity-matched analysis. Patients were grouped as Hispanic, non-Hispanic Black, non-Hispanic White, or non-Hispanic other individuals, where "non-Hispanic other" consists of all patients who did not identify as Hispanic, Black, or White. Health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire. Outcomes were analyzed with multivariable models that included race and ethnicity, ARNI initiation, and an interaction term between race and ethnicity and ARNI initiation. Cox proportional hazards models were used for death/HF hospitalization, and multiple regression was used for change in Kansas City Cardiomyopathy Questionnaire score. The analysis included 1516 patients, with 758 patients in each group (ARNI and no ARNI). Changes in Kansas City Cardiomyopathy Questionnaire score after ARNI initiation were similar among all race and ethnicity groups (mean [SD], non-Hispanic White individuals, 3.5 [19.0]; non-Hispanic Black individuals, 2.0 [17.0]; non-Hispanic other individuals, 5.5 [20.3]; and Hispanic individuals, 3.2 [20.1]), with no statistically significant interaction between race and ethnicity and ARNI initiation (P=0.21). There was similarly no statistically significant interaction between race and ethnicity and ARNI initiation for HF hospitalization (P=0.82) or all-cause mortality (P=0.92).
Conclusions:
In a large registry of outpatients with HF with reduced ejection fraction, the association between ARNI initiation and outcomes did not differ by race and ethnicity. These data support the use of ARNI therapy for chronic HF with reduced ejection fraction irrespective of race and ethnicity.
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