Use of Hydralazine-Isosorbide Dinitrate combination in African American and Other Race/Ethnic Group Patients with Heart Failure and Reduced Ejection Fraction Harsh Golwala, MD; 1 Udho Thadani, MD; 1 Li Lang, MD, PhD; 2 Stavros Stavrakis, MD, PhD; 1 Javed Butler MD; 3 Clyde W. Yancy, MD; 4 Deepak L. Bhatt, MD, MPH; 5 Adrian Hernandez, MD, MHS; 2 Gregg C. Fonarow, MD 6 1 University of Oklahoma, Oklahoma City, OK; 2 Duke Clinical Research Institute, Durham, NC; 3 Emory University, Atlanta, GA; 4 Northwestern University, Chicago, IL; 5 VA Boston Healthcare System, Brigham and Women’s Hospital, Boston, MA; 6 UCLA Medical Center, Los Angeles, CA Results  ACC/AHA and HFSA guidelines recommend the use of Hydralazine-Isosorbide Dinitrate (H-ISDN) in self identified African American patients with heart failure and reduced ejection fraction (HFrEF). In addition, H-ISDN may be considered in non-African American patients with HFrEF who remains symptomatic on optimized standard therapy. Background  To determine the contemporary use of H-ISDN use over time in both African American and other racial/ethnic groups, trends in its use over time, as well as patient and hospital factors associated with its use. Objective Methods Conclusions Limitations  GWTG-HF is an ongoing, prospective registry and quality improvement program initiated in January 2005 by the American Heart Association (AHA)  122,395 patients admitted with HF were discharged from 207 hospitals participating in GWTG-HF program from April 1, 2008 through March 24,  Of these, patients with missing data on ejection fraction [n=3,868] or ejection fraction >40% [n=63,905] were excluded yielding a population of 54,622 HFrEF patients.  Further exclusions included unknown race or ethnicity [n=2,288], and documented contra-indication to H-ISDN therapy [n=2,508]. We also excluded patients who were comfort care only, or those who died, or who had missing information on discharge destination.  The final study population thus included 43,898 patients with HFrEF from 195 hospitals  Outcomes Sciences, a Quintiles Company, Cambridge, MA served as the data collection center and Duke Clinical Research Institute served as the data analysis center.  The data collection is dependent on the accuracy and completeness of data abstraction.  Measured and unmeasured confounding factors may impact findings.  Data do not include longitudinal follow-up, hence a portion of eligible patients may have been started on H- ISDN as an outpatient, underestimating its real use. However, previous data suggest that if a medication is not started at the time of discharge; subsequent new prescription rate in outpatient setting is low.  Finally, GWTG-HF hospitals are self-selected and may not be representative to all hospitals in the US.  Hydralazine-isosorbide dinitrate use in eligible African American patients with HFrEF remains very low in real world practice despite clinical trial evidence and guideline recommendations.  Although H-ISDN use has increased over time from 2008 through 2011, it has nevertheless remained less than 25% even in the African American patients.  Given the substantial morbidity and mortality faced by patients with HFrEF and the established efficacy of H- ISDN among African American patients, aggressive measures to facilitate adherence to H-ISDN should be sought. Table 1.Patient Characteristics by Hydralazine-Isosorbide Dinitrate Use at Hospital Discharge Figure 1. Current Use as Well as Trends in the Use of Hydralazine-isosorbide Dinitrate at Discharge in Eligible Patients from Table 2. Patient and Hospital Factors Associated with H-ISDN Use in Self-Identified African American Patients Figure 2. H-ISDN Use in African American Patients in Hospitals with at Least 10 Self- Identified African American Patients Hydralazine-Isosorbide dintrate use No. (%) Patient characteristics Total (n=43,898) Yes (n=5,515) No (n=38,383) P value Age, mean (SD), y 68.3 (15)65.4 (15)68.7 (15)<.0001 Male (%) <.0001 Race (Median) White <.001 African American Hispanic Others Hypertension (%) <.0001 Diabetes (%) <.0001 Hyperlipidemia (%) Atrial Fibrillation (%) <.0001 COPD (%) Peripheral vascular disease (%) <.0001 Coronary artery disease (%) CVA (%) <.0001 ICD (%) <.0001 Heart failure (%) <.0001 Pacemaker (%) CRT-P (%) CRT-D (%) <.0001 Chronic dialysis (%) <.0001 Smoking (%) Ejection fraction, mean (SD)24.7 (7.8)24.8 (7.8)24.7 (7.8)0.31 All values listed as mean ± standard deviation or %. Wilcoxon two-sample test performed for continuous variables. Chi-square test performed for categorical variables. Abbreviations: COPD, chronic obstructive pulmonary disease; CVA, cerebrovascular accident; ICD, Implantable cardioverter defibrillator; CRT- D,P= Cardiac resynchronization therapy- pacemaker, defibrillator VariableAdjusted ORP value Age, per 10 y0.90 ( )<0.001 Female vs. Male0.76 ( )<0.001 Uninsured vs Medicare0.82 ( ) COPD1.19 ( )0.001 Diabetes1.20 ( ) Hypertension1.30 ( ) ICD implantation1.36 ( )< Heart Failure1.39 ( )< Anemia1.27 ( ) Chronic dialysis0.59 ( ) Renal insufficiency2.33 ( )< Smoking0.82 ( ) Systolic BP. Per 10 mm Hg1.15 ( )< Heart rate, per 10 beats/min0.93 ( )< Hospital Bed size, per 500 beds1.77 ( ) Abbreviations: COPD, chronic obstructive pulmonary disease; ICD, implantable cardioverter defibrillator Race % of patients with H-ISDN discharge African American22.3 White8.9 Hispanics10.8 Others9.8 Disclosures: GWTG-HF program is provided by the AHA.GWTG-HF has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. This project was also supported by Young Investigator Database Research Seed Grant to Dr. Golwala -supported by the Council on Clinical Cardiology.