Among patients with HF with high-risk features, there is less utilization of ventricular assist devices (VADs) and
transplant among Black patients, with no increase in mortality, according to a study published in Circulation: Heart
Failure. Thomas M. Cascino, MD, and colleagues conducted an observational cohort study of ambulatory patients with chronic systolic HF with high-risk features and no contraindications to VAD to examine the association of race with VAD use. Among 377 participants, 26.5% identified as Black. VAD or transplant was used in 11% of Black and
22% of White participants; death occurred in 18% of Black participants and 13% of White participants. An association was observed between Black race and lower utilization of VAD and transplant (adjusted HR, 0.45), with no increase in death. Similar preferences were seen for VAD or life-sustaining therapies by race; this did not explain racial disparities. “Although unmeasured patient factors influencing VAD and transplant candidacy cannot be excluded, this residual inequity in VAD and transplant may result from structural racism and discrimination or provider biases impacting clinician decision making,” Dr. Cascino and colleagues wrote.
Beneficial Effect of Intensive BP Control Does Not Persist
The beneficial effect of intensive blood pressure (BP) treatment on cardiovascular and all-cause mortality does not persist, according to a study published in JAMA Cardiology. Byron C. Jaeger, PhD, and colleagues conducted a secondary analysis of a multicenter randomized clinical trial involving patients aged 50 or older with hypertension and increased cardiovascular risk to examine the long-term effects of randomization to intensive treatment. Participants were randomly assigned to a systolic blood pressure (SBP) goal of less than 120 mm Hg (intensive
treatment group; 4,678 participants) versus less than 140 mm Hg (standard treatment group; 4,683 participants). Intensive treatment was beneficial for cardiovascular and all-cause mortality (HRs [95% CIs], 0.66 [0.49-0.89] and 0.83 [0.68-1.01], respectively) during a median intervention period of 3.3 years. There was no longer evidence of benefit for cardiovascular or all-cause mortality at a median follow-up of 8.8 years (HRs [95% CIs], 1.02 [0.84-
1.24] and 1.08 [0.94-1.23], respectively). “Given steadily increasing mean SBP levels in participants randomized to intensive treatment after the trial, these results suggest that maintaining more intensive BP targets throughout adulthood will likely be essential for long-term cardiovascular disease risk management,” the authors wrote.