Changes In Prescribing Patterns For Sodium-glucose Cotransporter-2 Inhibitors, An Experience From A Tertiary Care Health System
HFSA ePoster Library. Egolum U. 09/10/21; 343635; 77
Ugochukwu Egolum
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Abstract
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Background: We explored the prognostic role of certain measures of heart failure (HF) severity in Black vs. Non-Black patients with HF with reduced ejection fraction (HFrEF).
Methods: Participants of the GUIDE-IT trial with measured N-terminal pro-B-type natriuretic peptide (NT-proBNP),New York Heart Association (NYHA) class, 6-minute walk distance (6-MWD), Meta‐Analysis Global Group in Chronic HF (MAGGIC) risk score, and quality-of-life (KCCQ) score were included. Multivariable adjusted Cox models were constructed to evaluate the associations of race and HF severity indices with risk of HF hospitalization and all-cause death in separate models. Interaction testing was performed between race and each HF severity measure.
Results: Among 894 participants, 36% were of self-reported Black race. There were 288 HF hospitalizations and 143 deaths. Black participants had higher rate of HF hospitalization (43% vs 26% in Black vs Non-Black participants). In adjusted analysis this association remained significant (aHR [95% CI] = 1.83 [1.40, 2.38]). Black participants had a lower mortality rate of 11% compared to 19% in Non-Black individuals. However, this association was attenuated and no longer significant after adjustment for confounders (aHR [95% CI] = 0.83 [0.55, 1.27]). An interaction was observed between race and NT-ProBNP and NYHA class respectively, such that both were more strongly associated with risk of HF hospitalization in Non-Black (aHR[95%CI]=1.59[1.33-1.89], aHR[95% CI]=2.07[1.46-2.95]) vs. Black patients (aHR[95%CI]=1.21[0.99-1.47], aHR[95% CI]=1.38[0.96-1.99]) (P-interaction<0.05 for both). Race also modified the association of 6-MWD and MAGGIC risk score with mortality risk (P-interaction race*6-MWD=0.08; race*MAGGIC score=0.05) such that both were associated with mortality in Non-Black (aHR[95%CI]=0.82[0.68-0.99]), (aHR[95% CI]=1.31[1.15-1.48]) vs Black patients (Table 1).
Conclusions: Self-reported race modifies the association of HF severity measures with the risk of adverse events.
Table 1. Multivariable-adjusted association between heart failure severity indices and risk of heart failure hospitalization and death stratified by race
Methods: Participants of the GUIDE-IT trial with measured N-terminal pro-B-type natriuretic peptide (NT-proBNP),New York Heart Association (NYHA) class, 6-minute walk distance (6-MWD), Meta‐Analysis Global Group in Chronic HF (MAGGIC) risk score, and quality-of-life (KCCQ) score were included. Multivariable adjusted Cox models were constructed to evaluate the associations of race and HF severity indices with risk of HF hospitalization and all-cause death in separate models. Interaction testing was performed between race and each HF severity measure.
Results: Among 894 participants, 36% were of self-reported Black race. There were 288 HF hospitalizations and 143 deaths. Black participants had higher rate of HF hospitalization (43% vs 26% in Black vs Non-Black participants). In adjusted analysis this association remained significant (aHR [95% CI] = 1.83 [1.40, 2.38]). Black participants had a lower mortality rate of 11% compared to 19% in Non-Black individuals. However, this association was attenuated and no longer significant after adjustment for confounders (aHR [95% CI] = 0.83 [0.55, 1.27]). An interaction was observed between race and NT-ProBNP and NYHA class respectively, such that both were more strongly associated with risk of HF hospitalization in Non-Black (aHR[95%CI]=1.59[1.33-1.89], aHR[95% CI]=2.07[1.46-2.95]) vs. Black patients (aHR[95%CI]=1.21[0.99-1.47], aHR[95% CI]=1.38[0.96-1.99]) (P-interaction<0.05 for both). Race also modified the association of 6-MWD and MAGGIC risk score with mortality risk (P-interaction race*6-MWD=0.08; race*MAGGIC score=0.05) such that both were associated with mortality in Non-Black (aHR[95%CI]=0.82[0.68-0.99]), (aHR[95% CI]=1.31[1.15-1.48]) vs Black patients (Table 1).
Conclusions: Self-reported race modifies the association of HF severity measures with the risk of adverse events.
Table 1. Multivariable-adjusted association between heart failure severity indices and risk of heart failure hospitalization and death stratified by race
Background: We explored the prognostic role of certain measures of heart failure (HF) severity in Black vs. Non-Black patients with HF with reduced ejection fraction (HFrEF).
Methods: Participants of the GUIDE-IT trial with measured N-terminal pro-B-type natriuretic peptide (NT-proBNP),New York Heart Association (NYHA) class, 6-minute walk distance (6-MWD), Meta‐Analysis Global Group in Chronic HF (MAGGIC) risk score, and quality-of-life (KCCQ) score were included. Multivariable adjusted Cox models were constructed to evaluate the associations of race and HF severity indices with risk of HF hospitalization and all-cause death in separate models. Interaction testing was performed between race and each HF severity measure.
Results: Among 894 participants, 36% were of self-reported Black race. There were 288 HF hospitalizations and 143 deaths. Black participants had higher rate of HF hospitalization (43% vs 26% in Black vs Non-Black participants). In adjusted analysis this association remained significant (aHR [95% CI] = 1.83 [1.40, 2.38]). Black participants had a lower mortality rate of 11% compared to 19% in Non-Black individuals. However, this association was attenuated and no longer significant after adjustment for confounders (aHR [95% CI] = 0.83 [0.55, 1.27]). An interaction was observed between race and NT-ProBNP and NYHA class respectively, such that both were more strongly associated with risk of HF hospitalization in Non-Black (aHR[95%CI]=1.59[1.33-1.89], aHR[95% CI]=2.07[1.46-2.95]) vs. Black patients (aHR[95%CI]=1.21[0.99-1.47], aHR[95% CI]=1.38[0.96-1.99]) (P-interaction<0.05 for both). Race also modified the association of 6-MWD and MAGGIC risk score with mortality risk (P-interaction race*6-MWD=0.08; race*MAGGIC score=0.05) such that both were associated with mortality in Non-Black (aHR[95%CI]=0.82[0.68-0.99]), (aHR[95% CI]=1.31[1.15-1.48]) vs Black patients (Table 1).
Conclusions: Self-reported race modifies the association of HF severity measures with the risk of adverse events.
Table 1. Multivariable-adjusted association between heart failure severity indices and risk of heart failure hospitalization and death stratified by race
Methods: Participants of the GUIDE-IT trial with measured N-terminal pro-B-type natriuretic peptide (NT-proBNP),New York Heart Association (NYHA) class, 6-minute walk distance (6-MWD), Meta‐Analysis Global Group in Chronic HF (MAGGIC) risk score, and quality-of-life (KCCQ) score were included. Multivariable adjusted Cox models were constructed to evaluate the associations of race and HF severity indices with risk of HF hospitalization and all-cause death in separate models. Interaction testing was performed between race and each HF severity measure.
Results: Among 894 participants, 36% were of self-reported Black race. There were 288 HF hospitalizations and 143 deaths. Black participants had higher rate of HF hospitalization (43% vs 26% in Black vs Non-Black participants). In adjusted analysis this association remained significant (aHR [95% CI] = 1.83 [1.40, 2.38]). Black participants had a lower mortality rate of 11% compared to 19% in Non-Black individuals. However, this association was attenuated and no longer significant after adjustment for confounders (aHR [95% CI] = 0.83 [0.55, 1.27]). An interaction was observed between race and NT-ProBNP and NYHA class respectively, such that both were more strongly associated with risk of HF hospitalization in Non-Black (aHR[95%CI]=1.59[1.33-1.89], aHR[95% CI]=2.07[1.46-2.95]) vs. Black patients (aHR[95%CI]=1.21[0.99-1.47], aHR[95% CI]=1.38[0.96-1.99]) (P-interaction<0.05 for both). Race also modified the association of 6-MWD and MAGGIC risk score with mortality risk (P-interaction race*6-MWD=0.08; race*MAGGIC score=0.05) such that both were associated with mortality in Non-Black (aHR[95%CI]=0.82[0.68-0.99]), (aHR[95% CI]=1.31[1.15-1.48]) vs Black patients (Table 1).
Conclusions: Self-reported race modifies the association of HF severity measures with the risk of adverse events.
Table 1. Multivariable-adjusted association between heart failure severity indices and risk of heart failure hospitalization and death stratified by race
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