Use of hydralazine-isosorbide dinitrate combination in African American and other race/ethnic group patients with heart failure and reduced left ventricular ejection fraction.

Hydralazine-isosorbide dinitrate (h-isdn) therapy is recommended for african american patients with moderate to severe heart failure with reduced ejection fraction (<40%) (hfref),but use,temporal trends,and clinical characteristics associated with h-isdn therapy in clinical practice are unknown. an observational analysis of 54 622 patients admitted with hfref and discharged home from 207 hospitals participating in the get with the guidelines-heart failure registry from april 2008 to march 2012 was conducted to assess prescription,trends,and predictors of use of h-isdn among eligible patients. among 11 185 african american patients eligible for h-isdn therapy,only 2500 (22.4%) received h-isdn therapy at discharge. in the overall eligible population,5115 of 43 498 (12.6%) received h-isdn at discharge. treatment rates increased over the study period from 16% to 24% among african americans and from 10% to 13% among the entire hfref population. in a multivariable model,factors associated with h-isdn use among the entire cohort included younger age; male sex; african american/hispanic ethnicity; and history of diabetes,hypertension,anemia,renal insufficiency,higher systolic blood pressure,and lower heart rate. in african american patients,these factors were similar; in addition,being uninsured was associated with lower use. overall,few potentially eligible patients with hfref are treated with h-isdn,and among african-americans fewer than one-fourth of eligible patients received guideline-recommended h-isdn therapy. improved ways to facilitate use of h-isdn therapy in african american patients with hfref are needed.