Clinical effectiveness of CRT and ICD therapy in heart failure patients by racial/ethnic classification: insights from the IMPROVE HF registry.
Clinical effectiveness of CRT and ICD therapy in heart failure patients by racial/ethnic classification: insights from the IMPROVE HF registry.
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DOI：
10.1016/j.jacc.2014.05.060
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发表时间：
2014-08-26
影响因子：
24
通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
--
作者：
Ziaeian, Boback;Zhang, Yan;Albert, Nancy M.;Curtis, Anne B.;Gheorghiade, Mihai;Heywood, J. Thomas;Mehra, Mandeep R.;O'Connor, Christopher M.;Reynolds, Dwight;Walsh, Mary Norine;Yancy, Clyde W.;Fonarow, Gregg C.
临床试验已证明心脏复律治疗（CRT）和植入式心律转复除颤器（ICD）治疗对射血分数降低的心力衰竭（HFrEF）患者有益;然而，器械治疗对少数人群的益处仍存在疑问。本研究的目的是确定CRT和ICD治疗在HFrEF门诊患者（射血分数≤35%）中的临床有效性，作为人种/种族的函数。根据符合指南的患者的器械状态和人种/种族分析了IMPROVE HF（改善门诊环境中循证心力衰竭治疗使用的登记研究）的数据，以确定24个月时的死亡率。进行了多变量广义估计方程分析，根据患者和实践特征进行调整。ICD/心脏除颤器（CRT-D）合格队列（n = 7，748）包括3，391例（44%）非西班牙裔白色患者、719例（9%）非西班牙裔黑人患者和3，638例（47%）其他种族/少数民族或未记录种族的患者。心脏起搏器（CRT-P）/CRT-D合格队列（n = 1，188）包括596例（50%）非西班牙裔白色患者、99例（8%）非西班牙裔黑人患者和493例（41%）其他/未记录患者。ICD/CRT-D治疗相关的临床获益（校正比值比：0.64，95%置信区间：0.52 - 0.79，24个月死亡率p = 0.0002），在白色、黑人和其他少数民族/未记录患者中的比例相似（器械-人种/种族相互作用p = 0.7861）。对于CRT-P/CRT-D治疗，也存在相关的死亡率获益（校正比值比：0.55，95%置信区间：0.33 - 0.91，p = 0.0222），器械-人种/种族相互作用不显著（p = 0.5413）。指南指导的CRT和ICD治疗的使用与24个月死亡率降低相关，种族/民族组之间无显著相互作用。应向合格的心力衰竭患者提供器械治疗，不得基于人种/种族进行修改。
Clinical trials have demonstrated benefit for cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) therapies in patients with heart failure with reduced ejection fraction (HFrEF); yet, questions have been raised with regard to the benefit of device therapy for minorities. The purpose of this study was to determine the clinical effectiveness of CRT and ICD therapies as a function of race/ethnicity in outpatients with HFrEF (ejection fraction ≤35%). Data from IMPROVE HF (Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting) were analyzed by device status and race/ethnicity among guideline-eligible patients for mortality at 24 months. Multivariate Generalized Estimating Equations analyses were conducted, adjusting for patient and practice characteristics. The ICD/cardiac resynchronization defibrillator (CRT-D)–eligible cohort (n = 7,748) included 3,391 (44%) non-Hispanic white, 719 (9%) non-Hispanic black, and 3,638 (47%) other racial/ethnic minorities or race-not-documented patients. The cardiac resynchronization pacemaker (CRT-P)/CRT-D–eligible cohort (n = 1,188) included 596 (50%) non-Hispanic white, 99 (8%) non-Hispanic black, and 493 (41%) other/not-documented patients. There was clinical benefit associated with ICD/CRT-D therapy (adjusted odds ratio: 0.64, 95% confidence interval: 0.52 to 0.79, p = 0.0002 for 24-month mortality), which was of similar proportion in white, black, and other minority/not-documented patients (device–race/ethnicity interaction p = 0.7861). For CRT-P/CRT-D therapy, there were also associated mortality benefits (adjusted odds ratio: 0.55, 95% confidence interval: 0.33 to 0.91, p = 0.0222), and the device–race/ethnicity interaction was not significant (p = 0.5413). The use of guideline-directed CRT and ICD therapy was associated with reduced 24-month mortality without significant interaction by racial/ethnic group. Device therapies should be offered to eligible heart failure patients, without modification based on race/ethnicity.
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