Chapman Brittany, Hellkamp Anne S, Thomas Laine E, Albert Nancy M, Butler Javed, Patterson J Herbert, Hernandez Adrian F, Williams Fredonia B, Shen Xian, Spertus John A, Fonarow Gregg C, DeVore Adam D
Department of Medicine Duke University School of Medicine Durham NC.
Duke Clinical Research Institute Durham NC.
J Am Heart Assoc. 2022 Jun 20;11(12):e022889. doi: 10.1161/JAHA.121.022889.
Background There are limited data on the use of angiotensin receptor neprilysin inhibitors (ARNIs) in minority populations with heart failure (HF) with reduced ejection fraction. We used data from the CHAMP-HF (Change the Management of Patients With Heart Failure) registry to evaluate ARNI initiation and associated changes in health status and clinical outcomes across different races and ethnicities. Methods and Results CHAMP-HF was a prospective, observational registry of US outpatients with chronic HF with reduced ejection fraction. We compared patients starting ARNI with patients not starting ARNI using a propensity-matched analysis. Patients were grouped as Hispanic, non-Hispanic Black, non-Hispanic White, or non-Hispanic other individuals, where "non-Hispanic other" consists of all patients who did not identify as Hispanic, Black, or White. Health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire. Outcomes were analyzed with multivariable models that included race and ethnicity, ARNI initiation, and an interaction term between race and ethnicity and ARNI initiation. Cox proportional hazards models were used for death/HF hospitalization, and multiple regression was used for change in Kansas City Cardiomyopathy Questionnaire score. The analysis included 1516 patients, with 758 patients in each group (ARNI and no ARNI). Changes in Kansas City Cardiomyopathy Questionnaire score after ARNI initiation were similar among all race and ethnicity groups (mean [SD], non-Hispanic White individuals, 3.5 [19.0]; non-Hispanic Black individuals, 2.0 [17.0]; non-Hispanic other individuals, 5.5 [20.3]; and Hispanic individuals, 3.2 [20.1]), with no statistically significant interaction between race and ethnicity and ARNI initiation (=0.21). There was similarly no statistically significant interaction between race and ethnicity and ARNI initiation for HF hospitalization (=0.82) or all-cause mortality (=0.92). Conclusions In a large registry of outpatients with HF with reduced ejection fraction, the association between ARNI initiation and outcomes did not differ by race and ethnicity. These data support the use of ARNI therapy for chronic HF with reduced ejection fraction irrespective of race and ethnicity.
关于血管紧张素受体脑啡肽酶抑制剂（ARNI）在射血分数降低的心力衰竭（HF）少数族裔人群中的应用数据有限。我们利用来自CHAMP-HF（改变心力衰竭患者管理）注册研究的数据，评估不同种族和族裔中ARNI的起始使用情况以及健康状况和临床结局的相关变化。
CHAMP-HF是一项针对美国射血分数降低的慢性HF门诊患者的前瞻性观察性注册研究。我们使用倾向匹配分析比较了开始使用ARNI的患者和未开始使用ARNI的患者。患者被分为西班牙裔、非西班牙裔黑人、非西班牙裔白人或非西班牙裔其他个体，其中“非西班牙裔其他”包括所有未认定为西班牙裔、黑人或白人的患者。使用12项堪萨斯城心肌病问卷评估健康状况。使用包括种族和族裔、ARNI起始使用情况以及种族和族裔与ARNI起始使用情况之间的交互项的多变量模型分析结局。Cox比例风险模型用于分析死亡/HF住院情况，多元回归用于分析堪萨斯城心肌病问卷评分的变化。该分析纳入了1516例患者，每组（ARNI组和未使用ARNI组）各有758例患者。在所有种族和族裔组中，开始使用ARNI后堪萨斯城心肌病问卷评分的变化相似（均值[标准差]，非西班牙裔白人个体为3.5[19.0]；非西班牙裔黑人个体为2.0[17.0]；非西班牙裔其他个体为5.5[20.3]；西班牙裔个体为3.2[20.1]），种族和族裔与ARNI起始使用情况之间无统计学显著交互作用（P=0.21）。在HF住院（P=0.82）或全因死亡率（P=0.92）方面，种族和族裔与ARNI起始使用情况之间同样无统计学显著交互作用。
在一个大型的射血分数降低的HF门诊患者注册研究中，ARNI起始使用与结局之间的关联在不同种族和族裔中并无差异。这些数据支持无论种族和族裔如何，均可将ARNI疗法用于射血分数降低的慢性HF。
