{"id":"0b4de26c8c92","type":"article","url":"https://hartvaat.nl/2026/09/01/zwarte-hfref-patienten-krijgen-vaker-acei-arni-en-mra-op-doeldosis-dan-witte-pat/","title":"Zwarte HFrEF-patiënten krijgen vaker ACEi/ARNi en MRA op doeldosis dan witte patiënten","title_en":"Comparison of Guideline-Directed Medical Therapy in Black versus White Patients With Heart Failure With Reduced Ejection Fraction in a Large, Integrated Health Care System.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Clinical cardiology","doi":"10.1002/clc.70452","source_url":"https://doi.org/10.1002/clc.70452","authors":["Natalia C Berry","Yi-Shin Sheu","Karen Chesbrough","R Clayton Bishop","Suma Vupputuri"],"significance":5,"published":"2026-09-08","source_date":"2026-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"A real-world cohort study examined racial differences in guideline-directed medical therapy use and target dosing among patients with heart failure with reduced ejection fraction. Black patients had significantly higher odds of receiving ACEi/ARB/ARNi (OR 2.0) and mineralocorticoid receptor antagonists (OR 1.6) at target doses compared to White patients, while beta-blocker and SGLT2 inhibitor usage was similar between groups. These findings highlight that prescribing disparities in HFrEF do not uniformly disadvantage Black patients, underscoring the need for continuous quality monitoring and outcome-focused research.","created":"2026-09-02T01:00:28Z","updated":"2026-09-02T01:00:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een observationeel onderzoek binnen een groot zorgsysteem vergeleek het gebruik en de dosering van richtlijnconforme medicatie bij zwarte versus witte patiënten met hartfalen met een verminderde ejectiefractie (HFrEF). Zwarte patiënten hadden significant hogere kansen om ACEi/ARB/ARNi (OR 2,0) en mineralocorticoidreceptorantagonisten (OR 1,6) op de doeldosis te krijgen, terwijl het gebruik van bètablokkers en SGLT2-remmers tussen de groepen vergelijkbaar was. Deze bevindingen tonen aan dat dispariteiten in HFrEF-behandeling niet altijd in het nadeel zijn van zwarte patiënten, wat belangrijk is voor het monitoren van behandelkwaliteit en toekomstig outcome-onderzoek.","abstract_original":"BACKGROUND: Guideline-directed medical therapy (GDMT) improves clinical outcomes for patients with heart failure with reduced ejection fraction (HFrEF). While GDMT treatment differences have been described for Black patients, data are limited. AIMS: We sought to evaluate, among Black and White HFrEF patients, differences in GDMT use and target dosing by race. MATERIALS & METHODS: We examined health records of Black and White patients with HFrEF between 2015 and 2022. GDMT was defined by four medication classes-ACEi/ARB/ARNi, beta blocker (BB), mineralocorticoid receptor antagonist (MRA), and SGLT2i. Proportions of patients on GDMT and achieving target dose were examined for each class. Logistic regression was used to assess variables associated with differential GDMT use and dosing. RESULTS: Our cohort totaled 2825 HFrEF patients (61.2% Black; 38.8% White). Compared to White patients, Black patients had higher treatment with ACEi/ARB/ARNi (84.1% vs. 80.0%), BB (85.3% vs. 74.9%), and MRA (27.9% vs.18.4%), but similar SGLT2i treatment. Among treated, Black patients were more likely to be treated to target with ACEi/ARB/ARNi (45.2% vs. 34.2%), BB (25.0% vs. 17.8%), and MRA (80.3% vs. 72.1%). After multivariate adjustment, MRA treatment was associated with race (OR = 1.39; 95% CI: 1.10-1.75). Among treated, Black patients had higher odds of treatment to target with ACEi/ARB/ARNi (OR = 2.0; 95% CI: 1.61-2.53) and MRA (OR = 1.6; 95% CI: 1.01-2.57). CONCLUSIONS: Using real-world data from a diverse health system, we demonstrated that Black patients had 2.0 times and 1.6 times greater odds of being treated to target with ACEi/ARB/ARNi and MRAs, respectively, compared to White patients. Future research should explore whether these differences translate to improved health outcomes."}