Understanding the Complexity of Heart Failure Risk and Treatment in Black Patients.
Understanding the Complexity of Heart Failure Risk and Treatment in Black Patients.
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DOI：
10.1161/circheartfailure.120.007264
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发表时间：
2020-08
期刊：
影响因子：
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通讯作者：
Morris AA
中科院分区：
文献类型：
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作者：
Nayak A;Hicks AJ;Morris AA
尽管心力衰竭(HF)患者的护理在过去十年中有所改善，但不同种族/民族在心力衰竭预后方面仍然存在重大差异。非裔美国人的年龄调整后心力衰竭相关心血管疾病的死亡率更高，特别是年轻的非裔美国人，他们的死亡率分别是白人男性和女性的2.6倍和2.97倍。同样，非裔美国人的心力衰竭住院率几乎是白人的2.5倍，在心力衰竭住院后的第一年，费用明显更高。虽然其他种族/少数民族的心力衰竭住院率有所改善，但在过去十年中，非裔美国人和白人患者之间的心力衰竭住院差距并未缩小。虽然获得护理和社会经济地位一直是对观察到的心力衰竭结局中种族差异的传统解释，但当代数据表明，包括遗传易感性以及健康的社会决定因素和隐性偏见在内的新因素可能在健康结局中发挥比以前认识到的更大的作用。这篇综述的目的是描述影响心力衰竭发病率、患病率和疾病严重性的种族差异的因素的复杂相互作用，重点介绍将影响临床护理的不断发展的知识，并解决未来改善非裔美国人心力衰竭差异的研究需要。
Although care of patients with heart failure (HF) has improved in the past decade, important disparities in HF outcomes persist based on race/ethnicity. Age-adjusted HF-related cardiovascular disease death rates are higher for African American patients, particularly among young African Americans whose rates of death are 2.6- and 2.97-fold higher, respectively, than White men and women. Similarly, the rate of HF hospitalization for African American men and women is nearly 2.5-fold higher when compared with whites, with costs that are significantly higher in the first year after HF hospitalization. While the relative rate of HF hospitalization has improved for other race/ethnic minorities, the disparity in HF hospitalization between African American and White patients has not decreased during the last decade. Although access to care and socioeconomic status have been traditional explanations for the observed racial disparities in HF outcomes, contemporary data suggest that novel factors including genetic susceptibility, as well as social determinants of health and implicit bias may play a larger role in health outcomes than previously appreciated. The purpose of this review is to describe the complex interplay of factors that influence racial disparities in HF incidence, prevalence, and disease severity, with a highlight on evolving knowledge that will impact the clinical care, and address future research needs to improve HF disparities in African Americans.