Racial and Ethnic Differences in Cardiac Surveillance Evaluation of Patients Treated With Anthracycline-Based Chemotherapy.
Racial and Ethnic Differences in Cardiac Surveillance Evaluation of Patients Treated With Anthracycline-Based Chemotherapy.
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DOI：
10.1161/jaha.122.027981
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发表时间：
2023-05-16
影响因子：
5.4
通讯作者：
Gong, Yan
中科院分区：
文献类型：
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作者：
DeRemer, David L.;Nguyen, Nam K.;Guha, Avirup;Ahmad, Faraz S.;Cooper-DeHoff, Rhonda M.;Pepine, Carl J.;Fradley, Michael G.;Gong, Yan
蒽环类药物仍然是许多恶性肿瘤的关键治疗方法，但会增加心力衰竭或心肌病的风险。具体指南建议在治疗前和治疗后 6 至 12 个月进行超声心动图和血清心脏生物标志物如 BNP（B 型利尿钠肽）或 NT-proBNP（N 末端 proBNP）评估。我们的目的是评估接触蒽环类药物后癌症幸存者心脏监测中种族和民族之间的关联。 OneFlorida 联盟中既往无心血管疾病且接受至少 2 个周期蒽环类药物治疗的成年患者纳入分析。采用多变量逻辑回归来估计不同种族和族裔群体在蒽环类药物治疗前、治疗后 6 个月和治疗后 12 个月基线时接受心脏监测的比值比 (OR) 和 95% CI。在 5430 名患者的整个队列中，63.4% 的患者进行了基线超声心动图检查，22.3% 的患者在 6 个月时接受了超声心动图检查，25% 的患者在 12 个月时接受了超声心动图检查。非西班牙裔黑人 (NHB) 患者接受基线超声心动图检查的可能性低于非西班牙裔白人 (NHW) 患者（OR，0.75 [95% CI，0.63–0.88]；P=0.0006）或任何基线心脏监测（OR，0.76 [95% CI，0.64–0.89]；P=0.001）。与 NHW 患者相比，西班牙裔患者在 6 个月（OR，0.84 [95% CI，0.72–0.98]；P=0.03）和 12 个月（OR，0.85 [95% CI，0.74–0.98]；P=0.03）时间点接受的心脏监测分别明显较少。 NHB 和西班牙裔队列中癌症幸存者在基线时和接受蒽环类药物治疗后的心脏监测存在显着的种族和民族差异。卫生保健提供者需要认识到这些社会不平等，并努力确保在使用蒽环类药物后进行建议的心脏监测。
Anthracyclines remain a key treatment for many malignancies but can increase the risk of heart failure or cardiomyopathy. Specific guidelines recommend echocardiography and serum cardiac biomarkers such as BNP (B‐type natriuretic peptide) or NT‐proBNP (N‐terminal proBNP) evaluation before and 6 to 12 months after treatment. Our objective was to evaluate associations between racial and ethnic groups in cardiac surveillance of survivors of cancer after exposure to anthracyclines. Adult patients in the OneFlorida Consortium without prior cardiovascular disease who received at least 2 cycles of anthracyclines were included in the analysis. Multivariable logistic regression was performed to estimate the odds ratios (ORs) and 95% CIs for receiving cardiac surveillance at baseline before anthracycline therapy, 6 months after, and 12 months after anthracycline exposure among different racial and ethnic groups. Among the entire cohort of 5430 patients, 63.4% had a baseline echocardiogram, with 22.3% receiving an echocardiogram at 6 months and 25% at 12 months. Non‐Hispanic Black (NHB) patients had a lower likelihood of receiving a baseline echocardiogram than Non‐Hispanic White (NHW) patients (OR, 0.75 [95% CI, 0.63–0.88]; P=0.0006) or any baseline cardiac surveillance (OR, 0.76 [95% CI, 0.64–0.89]; P=0.001). Compared with NHW patients, Hispanic patients received significantly less cardiac surveillance at the 6‐month (OR, 0.84 [95% CI, 0.72–0.98]; P=0.03) and 12‐month (OR, 0.85 [95% CI, 0.74–0.98]; P=0.03) time points, respectively. There were significant racial and ethnic differences in cardiac surveillance among survivors of cancer at baseline and following anthracycline‐based treatment in NHB and Hispanic cohorts. Health care providers need to be cognizant of these social inequities and initiate efforts to ensure recommended cardiac surveillance occurs following anthracyclines.