Race and Improvements in the Use of Guideline-Recommended Therapies for Patients With Heart Failure: Findings From IMPROVE HF
Race and Improvements in the Use of Guideline-Recommended Therapies for Patients With Heart Failure: Findings From IMPROVE HF
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DOI：
10.1016/s0027-9684(15)30156-5
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发表时间：
2012-05-01
影响因子：
3.3
通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
--
作者：
Reynolds, Dwight;Albert, Nancy M.;Fonarow, Gregg C.
背景资料：种族与心力衰竭（HF）患者使用指南推荐疗法的差异有关。目的：评估基于实践的绩效改善干预是否与黑人、白色和种族无证患者循证护理的类似改善相关。方法：IMPROVE HF是对绩效改善干预措施的纵向评价，HF或既往心肌梗死且左心室射血分数小于或等于35%的门诊患者的基础治疗。7605例患者的数据可用。按患者种族（黑人、白色或未记录/缺失）分析血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、β受体阻滞剂、醛固酮拮抗剂、心脏复律治疗、植入式心律转复除颤器治疗、房颤抗凝剂和HF教育的使用变化。多变量分析确定变量独立相关的变化，在每个therapy.Results：有686名黑人患者（9.0%）和3238名白色患者（42.6%），和种族是无证的3537（46.5%）。黑人患者基线时β受体阻滞剂和醛固酮拮抗剂的使用率显著高于其他2组，24个月时黑人患者醛固酮拮抗剂的使用率和HF教育程度较高。3组中，干预后7种疗法中4种的使用率公平增加，黑人和白人患者7种个体质量指标中5种的治疗率相似。护理的改善是独立的race.Conclusions：这些研究结果提供了一些迹象表明，基于种族的差异，在提供以证据为基础的HF护理可能会减少在门诊心脏病学的做法。临床决策支持和绩效反馈的应用可能有助于公平地改善门诊患者的HF护理，无论患者种族如何。
Background: Race is associated with differences in use of guideline-recommended therapies for patients with heart failure (HF).Objective: To evaluate whether a practice-based performance improvement intervention is associated with similar improvements in evidence-based care for black, white, and race-undocumented patients.Methods: IMPROVE HF is a longitudinal evaluation of a performance improvement intervention on use of evidence-based therapies for outpatients with HF or prior myocardial infarction and left ventricular ejection fraction less than or equal to 35%. Data were available for 7605 patients. Changes in use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, aldosterone antagonist, cardiac resynchronization therapy, implantable cardioverter-defibrillator therapy, anticoagulant for atrial fibrillation, and HF education were analyzed by patient race (black, white, or undocumented/missing). Multivariate analyses identified variables independently associated with changes in each therapy.Results: There were 686 black patients (9.0%) and 3238 white patients (42.6%), and race was undocumented for 3537 (46.5%). Baseline use of beta-blockers and aldosterone antagonists was significantly higher in black patients than in the other 2 groups, and use of aldosterone antagonists and HF education was higher among black patients at 24 months. Postintervention use of 4 of 7 therapies increased equitably for the 3 groups, and treatment rates were similar between black and whitepatients for 5 of 7 individual quality measures. Improvements in care were independent of race.Conclusions: These findings offer some indication that race-based differences in delivery of evidence-based HF care may be decreasing in outpatient cardiology practices. Application of clinical decision support and performance feedback may facilitate equitable improvements in HF care in outpatient settings regardless of patient race.