Abstract 15985: Comparison of Survival Benefit From Angiotensin Inhibitors in Patients With Heart Failure and Reduced Ejection Fraction by Race and Genomic Ancestry

Abstract

Introduction: Definitive evidence for the efficacy of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) in Black Americans with heart failure and reduced ejection fraction (HFrEF) is deficient. It is based on retrospective data, and there were very few Black patients enrolled in the landmark ACEI/ARB trials. Moreover, self-reported race does not reliably reflect genomic ancestry, particularly in Black Americans. Therefore, the objective of this study was to assess ACEI/ARB associated survival benefit in a prospective cohort of HFrEF patients, by both self-reported race and proportion of African genomic ancestry. Methods: Insured HFrEF patients (n=989) were enrolled in a prospective genomic registry from 2007-2015. ACEI/ARB exposure (ACEI/ARBexp) was calculated from pharmacy claims as % target exposure, and the proportion of African ancestry was determined from genome-wide array data. Cox proportional hazards regression with time-dependent ACEI/ARBexp and adjusted for established risk factors tested the association with all-cause mortality by self-reported race and proportion of African ancestry (≤5% vs. ≥80%). Results: Overall, 36% of patients were female, 52% self-identified as Black, average age was 68±12 years, and the mean follow-up was 3.0 years. Self-reported Black patients were significantly younger, more were women, more often had hypertension and non-ischemic etiology, had lower LVEF, and mean proportion African genomic ancestry of 84%. ACEI/ARBexp was similar among self-reported Blacks and Whites (52% and 55%; p=0.228), as was mortality (121 [24%] and 121 [25%]; p=0.526). ACEI/ARBexp was associated with similar survival benefit in all groups (Table 1). Conclusions: In this prospective registry, estimates of survival benefit associated with ACEI/ARB use in HFrEF patients appear similar regardless of self-reported race or African genomic ancestry.