Heart Failure Treatment in African Americans

Heart Failure Treatment

• Two RCTs (V-HeFT I and A-HeFT) demonstrated the benefit of hydralazine-isosorbide dinitrate in self-identified African Americans with heart failure.
• However, uptake of this regimen has been modest due to complexity and drug-related adverse effects.

Omega-3 PUFA Supplementation

• Omega-3 PUFA supplementation can reduce cardiovascular events in patients with heart failure.
• The GISSI-HF trial showed that 1g of omega-3 PUFA reduced death among post-MI patients and significantly reduced death or admission to hospital for a cardiovascular event.
• Omega-3 PUFA therapy has been well tolerated, but may have a dose-related risk of AF in patients with cardiovascular risk.

Renin-Angiotensin System Inhibition

• Inhibition of the renin-angiotensin system is recommended to reduce morbidity and mortality in patients with HFrEF.
• An ARNi, ACEi, or ARB are recommended as first-line therapy.
• ARNi may be used as de novo treatment in patients with symptomatic chronic HFrEF to simplify management.

ACEi and ARB Therapy

• ACEi reduce morbidity and mortality in patients with HFrEF.
• ACEi should be started at low doses and titrated upward to doses shown to reduce the risk of cardiovascular events in clinical trials.
• ARB reduce mortality and hospitalizations in patients with HFrEF in large RCTs.

Dosing and Titration of Medications

• Clinical trials of ACEi, ARB, ARNi, beta blockers, and most other HFrEF medications started patients at low dose and increased the dose over time to a specified target dose.
• The highest tolerated dose is recommended if the target dose cannot be achieved.

Beta Blockers

• Beta blockers provide dose-dependent improvements in LVEF, reduction in HF hospitalizations, and reduction in all-cause mortality.

Heart Rate and Cardiovascular Outcomes

• Heart rate is a strong predictor of cardiovascular outcomes in patients with CVD, including HF.
• The SHIFT trial demonstrated that reducing heart rate improves cardiovascular outcomes.

Digoxin Therapy

• To date, there has been only 1 large-scale, RCT of digoxin in patients with HF.
• The trial showed no effect on mortality but modestly reduced the combined risk of death and hospitalization.
• Digoxin has also shown improvement in symptoms and exercise tolerance in mild to moderate HF.

This quiz covers the benefits and limitations of using hydralazine-isosorbide dinitrate in treating heart failure in African Americans, as established by RCTs V-HeFT I and A-HeFT.