Pahuja Mohit, Leifer Eric S, Clarke John-Ross D, Ahmad Tariq, Daubert Melissa A, Mark Daniel B, Cooper Lawton, Desvigne-Nickens Patrice, Fiuzat Mona, Adams Kirkwood, Ezekowitz Justin, Whellan David J, Januzzi James L, O'Connor Christopher M, Felker G Michael, Piña Ileana L
Medstar Georgetown University/Washington Hospital Center, Washington, DC, United States of America.
Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, MD, United States of America.
Prog Cardiovasc Dis. 2022 Mar-Apr;71:79-85. doi: 10.1016/j.pcad.2022.04.010. Epub 2022 Apr 29.
The GUIDE-IT trial was, a multicenter, randomized, parallel group, unblinded study that randomized patients to having heart failure therapy titrated to achieve an NT-proBNP <1000 pg/mL or to usual clinical care.
We performed pre-specified subgroup analysis to look for the race and ethnicity-based differences in clinical outcomes of patients who were able to achieve GDMT or target NT-proBNP concentration of ≤1000 pg/mL at 90 days of follow-up. There were 894 patients enrolled in GUIDE-IT study. Of these, 733 participants had available data on 90-day guideline directed triple therapy and 616 on NT-proBNP. 35% of the patients were Black and 6% were Hispanic. Black patients were younger, had more comorbidities, lower EF, and higher NYHA class compared with non-Black. Adjusting for 90-day NT-proBNP and important baseline covariates, Black patients were at a higher risk than non-Black patients for HF hospitalization [HR, 2.19; 95% CI, 1.51-3.17; p < 0.0001], but at a similar risk for mortality [HR, 0.85.; 95% CI, 0.44-1.66; p = 0.64]. Similar results were seen adjusting for 90-day GDMT [HF hospitalization: Black vs non-Black, HR: 1.97; 1.41-2.77, P < 0.0001; mortality: HR: 0.70; 0.39-1.26, p = 0.23]. There were no significant differences between Hispanic and non-Hispanic patients with respect to heart failure hospitalization, cardiovascular or all-cause mortality. Over the study period, Black and Hispanic patients experienced smaller changes in physical function and quality of life as measured by the Kansas City Cardiomyopathy Questionnaire overall score.
Compared to non-Black patients, Black patients in GUIDE-IT study had a higher risk of heart failure hospitalization, but a comparable risk of mortality, despite improved use of GDMT and achievement of similar biomarker targets.
GUIDE-IT试验是一项多中心、随机、平行组、非盲研究，将患者随机分为两组，一组接受心力衰竭治疗滴定以实现N末端脑钠肽前体（NT-proBNP）<1000 pg/mL，另一组接受常规临床护理。
我们进行了预先指定的亚组分析，以寻找在随访90天时能够实现指南指导的药物治疗（GDMT）或NT-proBNP浓度目标≤1000 pg/mL的患者临床结局中基于种族和民族的差异。GUIDE-IT研究共纳入894例患者。其中，733例参与者有90天指南指导三联治疗的可用数据，616例有NT-proBNP的可用数据。35%的患者为黑人，6%为西班牙裔。与非黑人患者相比，黑人患者更年轻，合并症更多，射血分数（EF）更低，纽约心脏协会（NYHA）心功能分级更高。在调整90天NT-proBNP和重要的基线协变量后，黑人患者因心力衰竭住院的风险高于非黑人患者[风险比（HR），2.19；95%置信区间（CI），1.51 - 3.17；p < 0.0001]，但死亡风险相似[HR，0.85；95% CI，0.44 - 1.66；p = 0.64]。在调整90天GDMT后也观察到类似结果[心力衰竭住院：黑人与非黑人，HR：1.97；1.41 - 2.77，P < 0.0001；死亡：HR：0.70；0.39 - 1.26，p = 0.23]。西班牙裔和非西班牙裔患者在心力衰竭住院、心血管或全因死亡率方面无显著差异。在研究期间，根据堪萨斯城心肌病问卷总分衡量，黑人和西班牙裔患者的身体功能和生活质量变化较小。
在GUIDE-IT研究中，与非黑人患者相比，黑人患者心力衰竭住院风险更高，但死亡风险相当，尽管GDMT的使用有所改善且生物标志物目标相似。
