Use of Hydralazine‐Isosorbide Dinitrate Combination in A frican A merican and Other Race/Ethnic Group Patients With Heart Failure and Reduced Left Ventricular Ejection Fraction

Background Hydralazine‐isosorbide dinitrate (H‐ ISDN ) therapy is recommended for A frican A merican patients with moderate to severe heart failure with reduced ejection fraction (<40%) ( HF r EF ), but use, temporal trends, and clinical characteristics associated with H‐ ISDN therapy in clinical practice are unknown. Methods and Results An observational analysis of 54 622 patients admitted with HF r EF and discharged home from 207 hospitals participating in the Get With The Guidelines– H eart F ailure 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 A frican A merican 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 A frican A mericans and from 10% to 13% among the entire HF r EF population. In a multivariable model, factors associated with H‐ ISDN use among the entire cohort included younger age; male sex; A frican A merican/Hispanic ethnicity; and history of diabetes, hypertension, anemia, renal insufficiency, higher systolic blood pressure, and lower heart rate. In A frican A merican patients, these factors were similar; in addition, being uninsured was associated with lower use. Conclusions Overall, few potentially eligible patients with HF r EF are treated with H‐ ISDN , and among A frican‐ A mericans fewer than one‐fourth of eligible patients received guideline‐recommended H‐ ISDN therapy. Improved ways to facilitate use of H‐ ISDN therapy in A frican A merican patients with HF r EF are needed.