Race and Ethnic and Sex Differences in Rhythm Control Treatment of Incident Atrial Fibrillation.
Race and Ethnic and Sex Differences in Rhythm Control Treatment of Incident Atrial Fibrillation.
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DOI：
10.2147/ceor.s402344
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发表时间：
2023
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心房颤动（AF）与相当大的发病率和死亡率相关。及时的管理和治疗对于减轻AF疾病负担至关重要。治疗因种族、族裔和性别而异，可能导致健康结果的不公平。为确定偶发性房颤患者在节律治疗方面的种族、种族和性别差异，使用2010-2019 Optum Clinformatics数据库（美国（US）商业保险患者的行政索赔数据），确定了首次诊断前后连续入组12个月的≥20岁偶发性房颤患者。按患者人种和种族（亚裔、西班牙裔、黑人vs白色）和性别（女性vs男性）比较房颤的节律控制治疗（消融、抗心律失常药物[AAD]和心脏复律）。多变量回归分析用于检查人种、种族和性别与心律控制房颤治疗的关系。共有77，932例患者被确定为新发AF。黑人和西班牙裔女性患者的CHA 2DS 2 VASc评分最高（4.3 ± 1.8），Elixhauser评分最高（4.1 ± 2.8和4.0 ± 6.7）。黑人男性接受AAD治疗（校正比值比[aOR] 0.87; 95%置信区间[CI]，0.79-0.96）或消融术（aOR，0.72; 95% CI，0.58-0.90）的可能性较小。与白色男性相比，所有组接受心脏复律的可能性均较低，亚洲女性的可能性最低[aOR，0.48; 95% CI，（0.37-0.63）]。黑人患者不太可能接受药物和程序性心律控制治疗。需要进一步的研究来了解种族和族裔群体以及AF女性治疗不足的驱动因素。
Atrial fibrillation (AF) is associated with considerable morbidity and mortality. Timely management and treatment is critical in alleviating AF disease burden. Variation in treatment by race and ethnic and sex could lead to inequities in health outcomes. To identify racial and ethnic and sex differences in rhythm treatment for patients with incident AF. Using 2010–2019 Optum Clinformatics database, an administrative claims data for commercially insured patients in the United States (US), incident AF patients ≥20 years old who were continuously enrolled 12-months pre- and post-index diagnosis were identified. Rhythm control treatment (ablation, antiarrhythmic drugs [AAD], and cardioversion) for AF were compared by patient race and ethnicity (Asian, Hispanic, Black vs White) and sex (female vs male). Multivariable regression analysis was used to examine the relationship of race and ethnicity and sex with rhythm control AF treatment. A total of 77,932 patients were identified with incident AF. Black and Hispanic female patients had the highest CHA2DS2VASc scores (4.3 ± 1.8) and Elixhauser scores (4.1 ± 2.8 and 4.0 ± 6.7), respectively. Black males were less likely to receive AAD treatment (adjusted odds ratio [aOR] 0.87; 95% confidence interval [CI], 0.79–0.96) or ablation (aOR, 0.72; 95% CI, 0.58–0.90). Compared to White males, all groups had lower likelihood of receiving cardioversion with Asian females having the lowest [aOR, 0.48; 95% CI, (0.37–0.63)]. Black patients were less likely to receive pharmacologic and procedural rhythm control therapies. Further research is needed to understand the drivers of undertreatment among racial and ethnic groups and females with AF.