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
|August 11, 2024
概括
患有心力衰竭 (HF) 的黑人患者的1年住院率高于白人患者. 准则导向医学治疗 (GDMT) 处方没有显示任何种族差异,这表明其他因素有助于这种心力衰竭差异.
科学领域:
- 心脏病学 心脏病学
- 健康 公平 卫生 公平
- 医疗保健服务研究 医疗服务研究
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%.
- 黑人患者面临HF的最高发病率和经历更严重的结果,突出需要解决护理的种族差异.
- 识别和缓解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.
- 评估没有接受指导方针导向药物治疗 (GDMT) 的患者比例,并探索GDMT处方中的潜在种族差异.
主要方法:
- 对被诊断患有HFrEF的退伍军人患者进行了回顾性图表审查.
- 这项研究包括来自退伍军人事务西纽约医疗保健系统的白人和黑人患者.
- 多变量后勤回归分析了HF入院概率,药物治疗数据确定了GDMT和种族差异中的差距.
主要成果:
- 在被录取的172名患者中,有22%的患者在一年内被录取. 与白人患者相比,黑人患者入院的可能性是白人患者的2.9倍 (P = 0.031).
- 为了实现GDMT目标,需要平均两种额外的药物和一种剂量优化.
- 在白人和黑人患者之间,没有观察到GDMT处方率或非GDMT患者比例的显著差异.
结论:
- 与白人患者相比,患有HFrEF的黑人患者患有与HF相关的住院病例的可能性更高.
- 虽然GDMT的处方是公平的,但也有机会优化治疗,这表明非药物因素可能导致差异.
- 药剂师可以在识别和解决GDMT优化需求方面发挥关键作用,有可能减少HF结果中的种族差异.
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