African-American Heart Failure Trial (A-HeFT)

Question 1

A-HeFT clinical question?

Answer 1

Among self-identified black patients with HFrEF, does the combination of isosorbide dinitrate and hydralazine improve survival compared to placebo?

Question 2

A-HeFT Bottom Line

Answer 2

Isosorbide dinitrate plus hydralazine improves survival and reduces hospitalization among black patients with HFrEF

Question 3

Why are ACEi, ARBs, Beta Blockers less effective in black individuals?

Answer 3

Black individuals may have less activity of the renin-angiotensin-aldosterone system (RAAS)

Question 4

Why was A-HeFT stopped early?

Answer 4

ISDN/hydralazine was associated with a nearly 40% reduction in all-cause mortality in addition to standard therapy with ACE inhibitors, beta-blockers, and diuretics.

Question 5

A-HeFT design, n

Answer 5

Multicenter, double-blinded, parallel-group, randomized, placebo-controlled trial, 1,050

Question 6

A-HeFT primary outcome?

Answer 6

Primary composite score (calculated from all-cause mortality, HF hospitalizations, and quality of life measurements)

Question 7

A-HeFT inclusion criteria

Answer 7

• Age ≥18 years
• Self-identified as black (of African descent)
• NYHA class III-IV HF ≥3 months
• Receiving stable doses of standard therapy, including ACE inhibitors or ARBs, β-blockers, digoxin, spironolactone, diuretics
• LV dysfunction within previous 6 months defined as:
• -Resting LVEF <35%
• -Resting LVEF <45% with LV end-diastolic diameter >2.9cm/m² of BSA or >6.5cm by echocardiogram

Question 8

what % of A-HeFT participants had NYHA class III heart failure?

Answer 8

96%

Question 9

A-HeFT groups

Answer 9

Randomized to ISDN/hydralazine or placebo, stratified according to use or nonuse of background β-blockers