1. Use of Hydralazine-Isosorbide Dinitrate combination in African American and Other Race/Ethnic Group Patients with Heart Failure and Reduced Ejection Fraction Harsh Golwala, MD; 1 Udho Thadani, MD; 1 Li Lang, MD, PhD; 2 Stavros Stavrakis, MD, PhD; 1 Javed Butler MD; 3 Clyde W. Yancy, MD; 4 Deepak L. Bhatt, MD, MPH; 5 Adrian Hernandez, MD, MHS; 2 Gregg C. Fonarow, MD 6 1 University of Oklahoma, Oklahoma City, OK; 2 Duke Clinical Research Institute, Durham, NC; 3 Emory University, Atlanta, GA; 4 Northwestern University, Chicago, IL; 5 VA Boston Healthcare System, Brigham and Women’s Hospital, Boston, MA; 6 UCLA Medical Center, Los Angeles, CA Results  ACC/AHA and HFSA guidelines recommend the use of Hydralazine-Isosorbide Dinitrate (H-ISDN) in self identified African American patients with heart failure and reduced ejection fraction (HFrEF). In addition, H-ISDN may be considered in non-African American patients with HFrEF who remains symptomatic on optimized standard therapy. Background  To determine the contemporary use of H-ISDN use over time in both African American and other racial/ethnic groups, trends in its use over time, as well as patient and hospital factors associated with its use. Objective Methods Conclusions Limitations  GWTG-HF is an ongoing, prospective registry and quality improvement program initiated in January 2005 by the American Heart Association (AHA)  122,395 patients admitted with HF were discharged from 207 hospitals participating in GWTG-HF program from April 1, 2008 through March 24, 2012.  Of these, patients with missing data on ejection fraction [n=3,868] or ejection fraction >40% [n=63,905] were excluded yielding a population of 54,622 HFrEF patients.  Further exclusions included unknown race or ethnicity [n=2,288], and documented contra-indication to H-ISDN therapy [n=2,508]. We also excluded patients who were comfort care only, or those who died, or who had missing information on discharge destination.  The final study population thus included 43,898 patients with HFrEF from 195 hospitals  Outcomes Sciences, a Quintiles Company, Cambridge, MA served as the data collection center and Duke Clinical Research Institute served as the data analysis center.  The data collection is dependent on the accuracy and completeness of data abstraction.  Measured and unmeasured confounding factors may impact findings.  Data do not include longitudinal follow-up, hence a portion of eligible patients may have been started on H- ISDN as an outpatient, underestimating its real use. However, previous data suggest that if a medication is not started at the time of discharge; subsequent new prescription rate in outpatient setting is low.  Finally, GWTG-HF hospitals are self-selected and may not be representative to all hospitals in the US.  Hydralazine-isosorbide dinitrate use in eligible African American patients with HFrEF remains very low in real world practice despite clinical trial evidence and guideline recommendations.  Although H-ISDN use has increased over time from 2008 through 2011, it has nevertheless remained less than 25% even in the African American patients.  Given the substantial morbidity and mortality faced by patients with HFrEF and the established efficacy of H- ISDN among African American patients, aggressive measures to facilitate adherence to H-ISDN should be sought. Table 1.Patient Characteristics by Hydralazine-Isosorbide Dinitrate Use at Hospital Discharge Figure 1. Current Use as Well as Trends in the Use of Hydralazine-isosorbide Dinitrate at Discharge in Eligible Patients from 2008-2011 Table 2. Patient and Hospital Factors Associated with H-ISDN Use in Self-Identified African American Patients Figure 2. H-ISDN Use in African American Patients in Hospitals with at Least 10 Self- Identified African American Patients Hydralazine-Isosorbide dintrate use No. (%) Patient characteristics Total (n=43,898) Yes (n=5,515) No (n=38,383) P value Age, mean (SD), y 68.3 (15)65.4 (15)68.7 (15)<.0001 Male (%) 62.465.861.9<.0001 Race (Median) White 61.343.663.8 <.001 African American 25.445.322.6 Hispanic 8.77.58.8 Others 4.43.44.62 Hypertension (%)74.282.173.1<.0001 Diabetes (%)41.250.539.9<.0001 Hyperlipidemia (%)48.250.147.90.003 Atrial Fibrillation (%)29.926.330.4<.0001 COPD (%)27.629.027.40.018 Peripheral vascular disease (%)11.613.611.3<.0001 Coronary artery disease (%)50.952.150.70.05 CVA (%)13.416.013.1<.0001 ICD (%)19.625.318.8<.0001 Heart failure (%)73.279.572.3<.0001 Pacemaker (%)14.313.514.40.08 CRT-P (%)0.8 0.64 CRT-D (%)8.812.18.3<.0001 Chronic dialysis (%)2.93.92.8<.0001 Smoking (%)21.822.021.810.78 Ejection fraction, mean (SD)24.7 (7.8)24.8 (7.8)24.7 (7.8)0.31 All values listed as mean ± standard deviation or %. Wilcoxon two-sample test performed for continuous variables. Chi-square test performed for categorical variables. Abbreviations: COPD, chronic obstructive pulmonary disease; CVA, cerebrovascular accident; ICD, Implantable cardioverter defibrillator; CRT- D,P= Cardiac resynchronization therapy- pacemaker, defibrillator VariableAdjusted ORP value Age, per 10 y0.90 (0.86-0.95)<0.001 Female vs. Male0.76 (0.68-0.85)<0.001 Uninsured vs Medicare0.82 (0.70-0.76)0.0118 COPD1.19 (1.07-1.31)0.001 Diabetes1.20 (1.07-1.35)0.0025 Hypertension1.30 (1.07-1.58)0.0084 ICD implantation1.36 (1.19-1.55)<0.0001 Heart Failure1.39 (1.23-1.58)<0.0001 Anemia1.27 (1.07-1.50)0.0052 Chronic dialysis0.59 (0.42-0.83)0.0028 Renal insufficiency2.33 (2.01-2.69)<0.0001 Smoking0.82 (0.72-0.93)0.0026 Systolic BP. Per 10 mm Hg1.15 (1.12-1.18)<0.0001 Heart rate, per 10 beats/min0.93 (0.91-0.95)<0.0001 Hospital Bed size, per 500 beds1.77 (1.24-2.52) 0.0018 Abbreviations: COPD, chronic obstructive pulmonary disease; ICD, implantable cardioverter defibrillator Race % of patients with H-ISDN discharge African American22.3 White8.9 Hispanics10.8 Others9.8 Disclosures: GWTG-HF program is provided by the AHA.GWTG-HF has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. This project was also supported by Young Investigator Database Research Seed Grant to Dr. Golwala -supported by the Council on Clinical Cardiology.