Other evidence-based heart failure therapies (e.g., angiotensin converting enzyme inhibitors, beta-blockers, and combinations) had a strong association with reduced mortality.In 1986, the Vasodilator in Heart Failure Trial (V-HeFT-I) demonstrated a survival benefit with the combination of hydralazine and isosorbide dinitrate (H-ISDN) compared to placebo.We used our clinical judgment and the distribution of the intervals between heart failure diagnosis and the initiation of H-ISDN shown in This retrospective cohort (historical prospective) study was approved by the Colorado Multiple Institutional Review Board.We used the set of ICD-9 codes proposed for use in performance measures for HFMWe obtained ambulatory care prescription data from the VHA’s Pharmacy Benefits Management Strategic Health Group (PBM/SHG).The dependent variables for our analyses were time to death from any cause and time to the first VHA HF hospitalization following diagnosis. Taylor AL, Ziesche S, Yancy C, et al. We chose to use three time intervals: 1-4 months, 5-12 months, and >12 months after HF diagnosis.We created propensity scores for the receipt of H-ISDN using logistic regression with the dependent variable any use of H-ISDN within six months of HF diagnosis and all the independent variables described above. Both outcomes were censored on September 30, 2005, and time to first hospitalization was censored at the time of death.We calculated the span of days for which the patient had prescriptions for both hydralazine and isosorbide dinitrate. Name must be less than 100 characters We used information in the year prior to the diagnosis of HF to define comorbidities, and thus did not assess the severity of HF or the occurrence of new comorbidities over time that might have influenced the initiation of H-ISDN. © 2019 The Authors. Epub 2017 Dec 1. This ethnic group is more likely to develop heart failure at a younger age than people of other ethnicities. Thus VHA pharmacy data likely provide relatively complete information about prescription drug exposures.In conclusion, we found no apparent benefit from H-ISDN in the sample as a whole, or within any racial/ethnic subgroup. This was demonstrated in the African-American Heart Failure Trial (A-HeFT trial) in 2004 when the risk reduction in the Black patients was 43% compared with that in the placebo. This large sample allowed us to evaluate outcomes in multiple subgroups.In contrast to many pharmaco-epidemiologic studies that have relied on inpatient prescription databases, we utilized data on every outpatient prescription dispensed to these patients through the VHA over a seven year period. Hydralazine and nitrate combination was the first treatment that showed improved survival of patients with heart failure with reduced left ventricular ejection fraction (HFREF) in the Vasodilator Heart Failure Trial (V-HeFT trial) in 1986. The Vasodilator-Heart Failure Trial I (V-HeFT I) sought to explore the effects of using a combination of hydralazine and isosorbide dinitrate in managing heart failure. Free PMC article Isosorbide dinitrate dilates (widens) blood vessels, making it easier for blood to flow through them and easier for the heart to pump. However, less than 40% of patients had been started on this combination within six months of their HF diagnosis.Although ascertainment of death was virtually complete, we were able to include only data on VHA hospitalizations. N Engl J Med. This showed a 34% reduction of mortality at 2 years of follo … As in all observational studies, we were unable to adjust for non-equivalent distribution of unmeasured covariates between individuals unexposed to H-ISDN and those exposed.Our sample was >98% male, limiting the generalizability of our findings to women. 2004;351(20):2049-2057. Survival in all patients recruited into V‐HeFT I (from Cohn Survival in all patients in the V‐HeFT II trial (from Cohn Survival in Black patients and White patients in the V‐HeFT II trial (from Carson Survival in Black patients and White patients in the V‐HeFT I trial (from Cohn A‐HeFT: 43% relative risk reduction for mortality derived from the addition of hydralazine and nitrates in Black patients with heart failure with reduced left ventricular ejection fraction (from Taylor Cumulative mortality rates over days since discharge for patients treated and not treated with hydralazine–isosorbide dinitrate (H‐ISDN) (from Ziaeian The New England Journal of Medicine. 2005:1-13. Isosorbide dinitrate dilates (widens) blood vessels, making it easier for blood to flow through them and easier for the heart to pump. Clipboard, Search History, and several other advanced features are temporarily unavailable. Clinical Effectiveness of Hydralazine-Isosorbide Dinitrate in African-American Patients With Heart Failure. Wiley Am J Cardiol. However, when H-ISDN was initiated more than 12 months after diagnosis, the hazard ratio was significantly increased (HR 1.51, 95% C.I.