在心力衰竭的三重指南导向医疗疗中,县级变化与减少喷射分数的心力衰竭
Rishi J Desai1, Danielle Stonely1, Naira Ikram1
1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
JACC. Advances
|August 12, 2024
概括
县级心力衰竭三重治疗的使用在美国各地有很大的差异. 较低的社会经济地位和较高比例的黑人患者和低收入补贴受益者与低于最佳的指导方针导向的医疗治疗启动相关.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 健康 公平 卫生 公平
背景情况:
- 目前的指导方针主张立即启动多种指导方针导向医学疗法 (GDMT) 课程,以治疗心力衰竭与减少喷射率 (HFrEF) 的心力衰竭.
- 同时启动这些疗法对于HFrEF管理中的最佳患者结果至关重要.
研究的目的:
- 评估美国各县对患有HFrEF的患者使用三重GDMT (β-阻断剂,氨酸- ангиотензин系统抑制剂或 ангиотензин受体 neprilysin 抑制剂和矿物质皮质醇受体对抗剂) 的差异.
- 确定与三倍GDMT吸收差异相关的县级因素.
主要方法:
- 一个回顾性队列研究利用医疗保险服务费索赔数据 (2013-2019).
- 分析包括美国2600个县的304,857名患者.
- 采用多级物流回归来解释县级集群,并评估社会经济指标与三重疗法使用之间的关联.
主要成果:
- 平均14.3%的患者接受了三重GDMT,县级差异很大 (范围:0%-54.5%).
- 三重疗法使用率最低的县表现出更差的社会经济指标,包括更高的失业率.
- 与使用率较高的县相比,使用率较低的县也有更高比例的黑人患者和接受低收入补贴的患者.
结论:
- 在美国,对于HFrEF患者采用三重GDMT存在显著的地理差异.
- 低于最佳的利用模式与县级的社会经济劣势有关,突出了潜在的健康公平问题.
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