Racial disparities in awareness and treatment of atrial fibrillation: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.
Racial disparities in awareness and treatment of atrial fibrillation: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.
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DOI：
10.1161/strokeaha.109.573907
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发表时间：
2010-04
期刊：
影响因子：
8.3
通讯作者：
Howard G
中科院分区：
文献类型：
--
作者：
Meschia JF;Merrill P;Soliman EZ;Howard VJ;Barrett KM;Zakai NA;Kleindorfer D;Safford M;Howard G
房颤（AF）患者的中风风险可降低约60%。对房颤的认识和治疗的差异可能导致卒中死亡率的种族和地理差异。目的是检查房颤诊断和华法林治疗意识的预测因素。卒中的地理和种族差异的原因（REGARDS）是一项全国性、基于人群的纵向研究，对30，239名≥ 45岁的黑人和白人进行了超采样，来自非洲裔美国人和东南部卒中带州。参与者于2003年1月至2007年10月入组。数据收集采用电话访谈，在家里的评价，和自我管理的问卷调查。房颤意识的主要变量定义为对“医生或其他健康专业人员是否告诉过您患有房颤”的肯定回答。以及是否有根据家庭药物清单进行治疗的证据。从基线ECG开始，432名个体（88名黑人和344名白色人）患有AF。其中，88%（360/409）至少有一个额外的CHADS 2卒中风险因素，60%（258/432）知道自己的AF。黑人知道自己的AF的几率是白人的三分之一（OR=0.32 {95% CI：0.20-0.52}）。在那些知道的人中，黑人接受华法林治疗的几率仅为白人的四分之一（OR=0.28 {0.13-0.60}）。黑人比白人更不可能意识到患有房颤或接受华法林治疗。华法林治疗种族差异的潜在原因需要进一步研究。
Warfarin reduces stroke risk by about 60% in patients with atrial fibrillation (AF). Differences in awareness and treatment of AF may contribute to racial and geographic disparities in stroke mortality. The objective was to examine predictors of awareness of the diagnosis of AF and treatment with warfarin. REasons for Geographic and Racial Differences in Stroke (REGARDS) is a national, population-based, longitudinal study of 30,239 blacks and whites ≥ 45 years old with oversampling from African Americans and the southeastern stroke belt states. Participants were enrolled Jan 2003–Oct 2007. Data were collected using telephone interview, in-home evaluation, and self-administered questionnaires. The main variable of awareness of AF was defined by a positive answer to “Has a doctor or other health professional ever told you that you had atrial fibrillation?” and whether there was evidence of treatment on the basis of an in-home medications inventory. From baseline ECG, 432 individuals (88 black and 344 white) had AF. Of these, 88% (360/409) had at least one additional CHADS2 stroke risk factor and 60% (258/432) were aware of their AF. The odds of blacks being aware of their AF were one-third that of whites (OR=0.32 {95% CI: 0.20-0.52}). Among those aware, the odds of blacks being treated with warfarin were only one-fourth as great as whites (OR=0.28 {0.13-0.60}). Blacks were less likely than whites to be aware of having atrial fibrillation or to be treated with warfarin. Potential reasons for the racial disparity in warfarin treatment warrant further investigation.