Racial and Gender Disparity in Achieving Optimal Medical Therapy for Inpatients with Peripheral Artery Disease.
Racial and Gender Disparity in Achieving Optimal Medical Therapy for Inpatients with Peripheral Artery Disease.
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发表时间：
2020
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通讯作者：
Ruddy JM
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作者：
Gober L;Bui A;Ruddy JM
外周动脉疾病 (PAD) 的最佳药物治疗包括他汀类药物和抗血小板药物，这种组合可以降低主要心血管事件的发生率。尽管有这些发现，许多患者仍然得不到治疗，该项目的目的是调查新诊断为 PAD 的住院患者开始抗血小板和他汀类药物治疗的比率，重点关注种族和性别的差异。对 2016 年 1 月 1 日至 2016 年 12 月 31 日期间在同一机构新诊断 PAD 的住院患者进行了回顾性图表审查。收集人口统计数据和合并症。主要结局包括出院时的抗血小板药物和他汀类药物处方。本研究纳入的 44 名患者主要是男性（59% vs. 41%）和非裔美国人（61% vs. 39%）。从入院到出院，他汀类药物处方从 70% 上升至 82%，抗血小板药物处方从 82% 上升至 91%。血管专家在开始药物治疗方面比非血管专家更成功，血管专家收治的患者的他汀类药物处方增加了 22%，抗血小板药物处方增加了 23%。有趣的是，当 ABI 报告在正常范围内时，他汀类药物的起始使用率尤其受到影响，仅为 40%。对于总患者样本，出院时未服用他汀类药物的患者更常见的是非裔美国人 (63%)，大多数是女性 (67%)。所有未接受抗血小板治疗而出院的患者均为非裔美国人，其中 50% 为女性。尽管有国家指导方针，外周动脉疾病 (PAD) 患者仍然在没有最佳药物治疗的情况下出院。这项研究表明，入职障碍可能包括种族、性别、入院服务或是否存在正常 ABI。有必要进行进一步调查，以确定提供者教育和全系统举措的有效途径。
Best medical therapy for peripheral artery disease (PAD) includes statin and anti-platelet agents, a combination shown to decrease rates of major cardiovascular events. Despite these findings, many patients remain undertreated and the objective of this project was to investigate the rate of initiating anti-platelet and statin therapy for inpatients newly diagnosed with PAD with a focus on disparities by race and sex. A retrospective chart review of inpatients with newly diagnosed PAD was performed between January 1, 2016 to December 31, 2016 at a single institution. Demographics and comorbid conditions were collected. Primary outcomes included antiplatelet and statin prescription at discharge. The 44 patients included in this study were predominantly male (59% vs. 41%) and African American (61% vs. 39%). Between admission and discharge, prescriptions rose from 70% to 82% for statin and 82% to 91% for anti-platelet agents. Vascular specialists were more successful than non-vascular specialists at initiating medical therapy, with statin prescriptions increasing 22% and anti-platelet prescriptions climbing 23% for those admitted to a vascular specialist. Interestingly, when the ABI was reported in the normal range, rates of statin initiation were particularly compromised at only 40%. For the total patient sample, those discharged without a statin were more commonly African American (63%) and the majority were female (67%). All patients discharged without an antiplatelet were African American and 50% were females. Despite national guidelines, patients with PAD continue to be discharged without optimal medical therapy. This study suggests that obstacles to initiation may include race, sex, admitting service, or presence of a normal ABI. Further investigation is warranted to determine effective avenues for provider education and system-wide initiatives.