在心脏衰竭与保存喷射率 (HFpEF) 和心脏衰竭与减少喷射率 (HFrEF) 之间的诊断利用模式的差异:全国性的分析
Kiki J Estes-Schmalzl1, Wondwossen T Lerebo2, Mitchell Wolden1
1Department of Health Sciences, University of Jamestown, Fargo, USA.
Cureus
|September 10, 2025
概括
诊断成像差异存在于心力衰竭与保留喷射分数 (HFpEF) 和心力衰竭与减少喷射分数 (HFrEF). 这些不平等是由种族,社会经济因素和地理因素驱动的,影响了护理获得.
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:
- 心力衰竭 (HF) 是疾病和住院的主要原因,具有明显的HFpEF和HFrEF表型.
- 诊断成像利用的差异可能导致HF患者的诊断不足和不平等的护理.
- 了解健康的社会决定因素 (SDoH) 对诊断成像的影响对于公平的护理至关重要.
研究的目的:
- 评估HFpEF和HFrEF之间的联合诊断成像利用的差异.
- 检查SDoH和医院区域对高频诊断成像差异的影响.
- 确定导致HF护理中诊断成像未充分利用的因素.
主要方法:
- 使用2020年全国住院患者样本 (NIS) 进行的回顾性横截面研究.
- 使用ICD-10代码识别了成年HF住院病例.
- 使用多变量后勤回归分析了诊断成像 (心声学,MRI,心脏导管) 和患者/医院一级因素之间的关联.
主要成果:
- 综合诊断成像的整体利用率低 (1.72%) 在647万次HF入院中.
- 观察到显著的种族差异:与白人患者相比,黑人患者HFpEF诊断的几率较低,但HFrEF诊断的几率较高.
- 收入,教育,就业和医院地区是成像差异的重要预测因素;心脏导管治疗与两种HF表型密切相关.
结论:
- 在HFpEF和HFrEF的诊断成像显著差异是由种族,社会经济地位和地理位置驱动的.
- 基本的诊断成像仍未得到充分利用,特别是在少数群体和弱势群体中.
- 有针对性的干预措施是必要的,以解决诊断获取障碍,并促进公平的HF护理.
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