African-American Heart Failure Trial (A-HeFT): Rationale, Design, and Methodology

Background: Hydralazine and isosorbide dinitrate combination (HISDN), angiotensinconverting enzyme inhibitors, and beta-blockers have improved outcomes in heart failure (HF). Analysis of previous trials has shown that HISDN appears especially beneficial in African American patients. Methods and Results: The African-American Heart Failure Trial (A-HeFT) is double-blind, placebo-controlled, and includes African American patients with stable New York Heart Association Class III-IV HF on standard therapy. Patients must have prior HF-related events and left ventricular ejection fraction (LVEF) 35% or LVEF 2.9 cm/m 2 . Randomization to addition of placebo or BiDil (Nitro Med, Inc., Bedford, MA), a fixed combination of HISDN, is stratified for beta-blocker usage. All patients are treated and followed until the last patient entered completes 6 months of follow-up. The primary efficacy endpoint is a composite score including quality of life, death, and hospitalization for HF. At least 600 patients will be randomized; the first was randomized in June 2001. Conclusions: In addition to providing additional information on BiDil efficacy in HF, A-HeFT is the first HF trial aimed at a selected subgroup of patients and the first to use a new composite HF score as its primary efficacy endpoint.