识别心力衰竭与减少喷射小部分的管理中的种族差异
Journal of the American Pharmacists Association : JAPhA
|December 13, 2023
概括
患有心力衰竭 (HF) 的黑人患者面临的再入院率高于白人患者. 虽然指导药物治疗 (GDMT) 的处方类似,但优化治疗是改善结果和解决HF护理中的种族差异的关键.
科学领域:
- 心脏病学 心脏病学
- 健康 公平 卫生 公平
- 药物治疗 药物治疗
背景情况:
- 心力衰竭 (HF) 是一种慢性,渐进的疾病,心力衰竭的减少喷射率 (HFrEF) 定义为喷射率 (EF) <40%.
- 黑人患者患HF的发病率最高,并且受到其严重后果的影响不成比例,突出了解决护理种族差异的关键需要.
- 识别和减轻HF管理中的种族差异对于实现健康公平至关重要.
研究的目的:
- 调查HFrEF患者的种族 (白人与黑人) 和1年HF入院率之间的关联,以EF和年龄进行调整.
- 评估未接受指导药物治疗 (GDMT) 的患者比例,并确定其处方中的潜在种族差异.
主要方法:
- 在2021年10月至2022年11月期间,在VA西纽约医疗保健系统诊断出HFrEF的退伍军人患者进行了回顾性图表审查.
- 这项研究包括172名白人和黑人患者,利用VA心力衰竭仪表板的数据.
- 多变量后勤回归分析了HF入院的几率,而药物治疗数据则检查了GDMT差距和种族差异.
主要成果:
- 与白人患者相比,黑人患者在一年内因HF入院的可能性是黑人患者的2.9倍 (P = 0.031).
- 平均两种额外的药物和一种剂量优化被确定为实现GDMT目标的潜在改善.
- 在白人和黑人患者之间,没有观察到GDMT的处方或未服用GDMT的患者在推剂量中的比例的显著差异.
结论:
- 与白人患者相比,黑人患者出现HF再入院的可能性更高.
- 药剂师可以在确定优化GDMT的机会方面发挥关键作用,从而解决潜在的差异.
- 未来的研究应该探索药剂师领导的潜在干预措施,以有效地减少HF护理中的种族差异.
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