Premium
Cardiac resynchronization therapy: A comparative analysis of mortality in African Americans and Caucasians
Author(s) -
Fontaine John M.,
Franklin Sona M.,
Essilfie Gilbert,
Ahiable Lilian E.
Publication year - 2018
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13326
Subject(s) - medicine , ejection fraction , cardiac resynchronization therapy , cardiology , heart failure , proportional hazards model , renal function , confidence interval
Abstract Background Cardiac resynchronization therapy (CRT) is recommended in patients with heart failure, reduced left ventricular ejection fraction, and a prolonged QRS duration. African Americans are underrepresented in clinical trials and CRT is underutilized; consequently, the benefits and outcomes of CRT are not well‐defined. Methods We evaluated 294 patients, determined survival using Kaplan‐Meier analysis, and used Cox proportional hazards regression model to determine predictors of mortality. Propensity score‐match analysis was applied to balance covariates in African Americans and Caucasians. Results The mean age for African Americans (n = 131) and Caucasians (n = 163) was 65 ± 12 and 70 ± 13 years (P = 0.0003). Mortality in African Americans was 28% compared to 37% in Caucasians (P = 0.14) over a median follow‐up of 8.1 ± 0.6 years. Survival was significantly reduced in African Americans and Caucasians with a glomerular filtration rate (GFR) < 60 (6.7 ± 0.4, 95% confidence interval [CI]: 5.9–7.5 vs 8.6 ± 0.5 CI: 7.7–9.5 years, P = 0.005), and those not treated with an aldosterone antagonist (7.1 ± 0.4, 95% CI: 6.5–7.9 vs 8.7 ± 0.6, 7.6–9.9 years, P = 0.04), respectively. Independent predictors of mortality were a GFR <60 and low left ventricular ejection fraction. In African Americans, ischemic cardiomyopathy (ICM) and lack of therapy with an angiotensin‐converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) were associated with increased mortality. Conclusions Long‐term survival benefit from CRT was similar in African Americans and Caucasians. A GFR < 60 and lack of therapy with an aldosterone antagonist were associated with decreased survival. Survival also was inversely related to the number of comorbidities. In African Americans, underutilization of an ACEI or ARB, and ICM were additional factors associated with increased mortality.