Racial Differences in Trends and Prognosis of Guideline-Directed Medical Therapy for Heart Failure with Reduced Ejection Fraction: the Atherosclerosis Risk in Communities (ARIC) Surveillance Study.
Racial Differences in Trends and Prognosis of Guideline-Directed Medical Therapy for Heart Failure with Reduced Ejection Fraction: the Atherosclerosis Risk in Communities (ARIC) Surveillance Study.
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射血分数降低的心力衰竭指南指导药物治疗的趋势和预后的种族差异：社区动脉粥样硬化风险 (ARIC) 监测研究。
DOI：
10.1007/s40615-021-01202-5
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发表时间：
2023
影响因子：
3.9
通讯作者：
Chang,PatriciaP
中科院分区：
文献类型：
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作者：
Mathews,Lena;Ding,Ning;Sang,Yingying;Loehr,LauraR;Shin,Jung-Im;Punjabi,NareshM;Bertoni,AlainG;Crews,DeidraC;Rosamond,WayneD;Coresh,Josef;Ndumele,ChiadiE;Matsushita,Kunihiro;Chang,PatriciaP
背景在社区环境中，针对射血分数降低的心力衰竭 (HFrEF) 的指南指导药物治疗 (GDMT) 中的种族差异尚未得到充分记录。方法在 ARIC 监测研究 (2005-2014) 中，我们使用加权回归模型来解释抽样设计，研究了出院时 GDMT 的种族差异、其时间趋势以及对住院 HFrEF 个体的预后影响。最佳 GDMT 定义为 β 受体阻滞剂 (BB)、盐皮质激素受体拮抗剂 (MRA) 和 ACE 抑制剂 (ACEI) 或血管紧张素 II 受体阻滞剂 (ARB)。可接受的 GDMT 包括 BB、MRA、ACEI/ARB 或肼苯哒嗪加硝酸盐 (H-N) 之一。结果 在 16,455 例（未加权= 3,669）HFrEF 病例中，47% 是黑人。只有 ~ 10%的人以最佳GDMT出院，黑人的比例高于白人（11.1% vs. 8.6%，p< 0.001）。两个种族群体中 BB 的使用率均≥80%，而黑人比白人更有可能接受 ACEI/ARB（62.0% 对 54.6%）和 MRA（18.0% 对 13.8%），H-N 的情况类似（21.8% 对 10.1%）。两组中最佳 GDMT 的使用均呈减少趋势，白人中 ACEI/ARB 的使用显着下降 (− 2.8%p< 0.01)，但两组中 H-N 的使用均增加 (+ 6.5% 和 + 9.2%，p< 0.01)。只有 ACEI/ARB 和 BB 与较低的 1 年死亡率相关。结论 出院时只有 10% 的 HFrEF 患者接受了最佳 GDMT，但黑人的情况比白人更是如此。 ACEI/ARB 在白人中的使用量有所下降，而 H-N 在两个种族中的使用量均有所增加。患有 HFrEF 的黑人和白人的 GDMT 利用率，特别是 ACEI/ARB，应该得到改善。
BackgroundRacial disparities in guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) have not been fully documented in a community setting.MethodsIn the ARIC Surveillance Study (2005–2014), we examined racial differences in GDMT at discharge, its temporal trends, and the prognostic impact among individuals with hospitalized HFrEF, using weighted regression models to account for sampling design. Optimal GDMT was defined as beta blockers (BB), mineralocorticoid receptor antagonist (MRA) and ACE inhibitors (ACEI) or angiotensin II receptor blockers (ARB). Acceptable GDMT included either one of BB, MRA, ACEI/ARB or hydralazine plus nitrates (H-N).ResultsOf 16,455 (unweightedn= 3,669) HFrEF cases, 47% were Black. Only ~ 10% were discharged with optimal GDMT with higher proportion in Black than White individuals (11.1% vs. 8.6%,p< 0.001). BB use was > 80% in both racial groups while Black individuals were more likely to receive ACEI/ARB (62.0% vs. 54.6%) and MRA (18.0% vs. 13.8%) than Whites, with a similar pattern for H-N (21.8% vs. 10.1%). There was a trend of decreasing use of optimal GDMT in both groups, with significant decline of ACEI/ARB use in Whites (− 2.8%p< 0.01) but increasing H-N use in both groups (+ 6.5% and + 9.2%,p< 0.01). Only ACEI/ARB and BB were associated with lower 1-year mortality.ConclusionsOptimal GDMT was prescribed in only ~ 10% of HFrEF patients at discharge but was more so in Black than White individuals. ACEI/ARB use declined in Whites while H-N use increased in both races. GDMT utilization, particularly ACEI/ARB, should be improved in Black and Whites individuals with HFrEF.