在安全网环境中对心力衰竭进行冠状动脉评估:差异和结果
Matthew S Durstenfeld1, Anjali Thakkar1, Yifei Ma1
1Division of Cardiology at ZSFG and Department of Medicine, University of California, San Francisco (UCSF), USA.
medRxiv : the preprint server for health sciences
|July 18, 2023
概括
在心力衰竭 (HF) 诊断后的冠状动脉评估未得到充分利用,特别是在安全网人口中. 这项研究表明,冠状动脉评估可能会改善HF的结果,可能是通过增加再血管化和指导方针导向的医疗治疗.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 健康差异 在健康上的差异
背景情况:
- 缺血性心肌病是心力衰竭 (HF) 的首要原因,但冠状动脉评估在诊断后并不常见.
- 在安全网人群中,与冠状动脉评估相关的转诊模式和结果仍未得到充分研究.
研究的目的:
- 为了确定与冠状动脉评估在安全网HF人群中完成相关的因素.
- 模拟一项试验,评估选择性冠状动脉评估与HF结果的关联.
主要方法:
- 使用电子健康记录队列 (2001-2019) 的人与HF.
- 确定了冠状动脉评估完成的因素 (血管造影,核应力,CT血管造影).
- 模拟了一项随机试验,使用倾向评分来评估结果 (死亡率,新兴血管造影) 和国家死亡记录.
主要成果:
- 在14829名HF患者中,有26.9%接受了冠状动脉评估;在诊断时未知CAD状况的患者中,有18.5%接受了评估.
- 女性和老年人接受评估的可能性较低,在人口统计学和临床因素之间存在差异.
- 冠状动脉评估与降低死亡率 (HR 0.84) 和复合结局相关,同时增加了血管再循环和医疗治疗.
结论:
- 在安全网人口中,冠状动脉诊断后冠状动脉评估的差异仍然存在,超出已知的CAD风险因素.
- 向试验模拟表明,随着冠状动脉评估,改善了HF结果,可能是由于再血管化和指导方针导向医学疗法 (GDMT).
- 关于未测量的混存在低确定性,需要进一步调查.
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