Race and Beta‐Blocker Survival Benefit in Patients With Heart Failure: An Investigation of Self‐Reported Race and Proportion of African Genetic Ancestry

Abstract

BackgroundIt remains unclear whether beta‐blockade is similarly effective in black patients with heart failure and reduced ejection fraction as in white patients, but self‐reported race is a complex social construct with both biological and environmental components. The objective of this study was to compare the reduction in mortality associated with beta‐blocker exposure in heart failure and reduced ejection fraction patients by both self‐reported race and by proportion African genetic ancestry.Methods and ResultsInsured patients with heart failure and reduced ejection fraction (n=1122) were included in a prospective registry at Henry Ford Health System. This included 575 self‐reported blacks (129 deaths, 22%) and 547 self‐reported whites (126 deaths, 23%) followed for a median 3.0 years. Beta‐blocker exposure (BBexp) was calculated from pharmacy claims, and the proportion of African genetic ancestry was determined from genome‐wide array data. Time‐dependent Cox proportional hazards regression was used to separately test the association of BBexp with all‐cause mortality by self‐reported race or by proportion of African genetic ancestry. Both sets of models were evaluated unadjusted and then adjusted for baseline risk factors and beta‐blocker propensity score. BBexp effect estimates were protective and of similar magnitude both by self‐reported race and by African genetic ancestry (adjusted hazard ratio=0.56 in blacks and adjusted hazard ratio=0.48 in whites). The tests for interactions with BBexp for both self‐reported race and for African genetic ancestry were not statistically significant in any model (P>0.1 for all).ConclusionsAmong black and white patients with heart failure and reduced ejection fraction, reduction in all‐cause mortality associated with BBexp was similar, regardless of self‐reported race or proportion African genetic ancestry.

Performance of the Meta-Analysis Global Group in Chronic Heart Failure Score in Black Patients Compared With Whites

“…Death data was established using multiple sources including health system records, State of Michigan death records, and the social security death master file. Our group and others have used similar approaches previously to establish vital status, [13][14][15] and empiric data indicates that the source of death data (whether social security master file or national death index for example) does not impact inference regarding disparities in survival by race. 16 Among the prospective cohort all patients had complete follow up to one year (i.e., either known death at any point or confirmed interaction with patient beyond one year), while for the retrospective hospital discharge cohort 6 patients (0.24%) were lost to follow up.…”

Suppression tumorigenicity 2 (ST2) turbidimetric immunoassay compared to enzyme-linked immunosorbent assay in predicting survival in heart failure patients with reduced ejection fraction

“…The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution's human research committee. Study participants were part of the Henry Ford Pharmacogenomic Registry, which has been described in detail previously (16). Briefly, the registry enrolled patients from October 2007 to March 2015 who met Framingham criterion for HF (17), had a clinical ejection fraction measured by any modality and who were receiving care through Henry Ford Health System.…”

Social Inequalities in Non-ischemic Cardiomyopathies

“…It showed that low employment status, low-income level, low educational level, or birth in a foreign country affected the continuation of ACEI. Meanwhile, the study in the United States did not demonstrate racial differences in the survival benefit derived from the use of beta-blockers ( 19 ). According to the up-titration of beta blocker to the optimal dose, some disparities might be developed by the availabilities of the support for good adherence ( 20 , 21 ).…”