Racial Differences in Heart Failure Outcomes Evidence From the Tele-HF Trial (Telemonitoring to Improve Heart Failure Outcomes)
Racial Differences in Heart Failure Outcomes Evidence From the Tele-HF Trial (Telemonitoring to Improve Heart Failure Outcomes)
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DOI：
10.1016/j.jchf.2015.03.005
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发表时间：
2015-07-01
影响因子：
13
通讯作者：
Krumholz, Harlan M.
中科院分区：
文献类型：
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作者：
Qian, Feng;Parzynski, Craig S.;Krumholz, Harlan M.
目的探讨心力衰竭住院患者报告的健康状况、死亡率和再住院情况是否存在种族差异。背景目前对心力衰竭住院后患者报告的预后是否存在种族差异知之甚少。方法我们分析了参加Tele-HF(远程监护改善心力衰竭结果)试验的1,427名患者(636名非西班牙裔美国人[45%]；791名非西班牙裔白人[55%])的数据。分别在基线、3个月和6个月时用堪萨斯城心肌病问卷(KCCQ)评估健康状况。结果尽管黑人患者在基线时报告了更好的调整后的健康状况(KCCQ总分中黑人和白人的差异为6.22；95%可信区间[CI]：2.98到9.46；p<；0.001)，但在调整了患者的人口统计学、合并症、临床化验值和基线KCCQ评分后，我们在3个月时发现患者报告的健康状况没有显著的种族差异(KCCQ评分中黑人和白人的差异：2.28；95%的可信区间：-0.84到5.41；P=0.15)或6个月(黑人与白人KCCQ评分差异：1.91；95%可信区间：-1.31~5.13；P=0.24)。结论与白人患者相比，黑人心力衰竭患者在入院后即刻报告的健康状况较好，但在3个月或6个月时并非如此。我们的研究未能表明，黑人患者在入院治疗后的健康状况方面处于不利地位。(C)2015年，由美国心脏病学会基金会提供。
OBJECTIVES The purpose of this study was to determine whether there are racial differences in patient-reported health status as well as mortality and rehospitalization after hospitalization for heart failure (HF).BACKGROUND Little is known about whether racial differences exist in patient-reported outcomes after HF hospitalization.METHODS We analyzed data from 1,427 patients (636 non-Hispanic African Americans [45%]; 791 non-Hispanic whites [55%]) enrolled in the Tele-HF (Telemonitoring to Improve Heart Failure Outcomes) trial. Health status was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline and then at 3 and 6 months. Generalized linear mixed models and propensity score methods were used to adjust for clustering within sites and differences between races.RESULTS Although black patients reported better adjusted health status at baseline (black vs. white difference in KCCQ summary scores was 6.22; 95% confidence interval [CI]: 2.98 to 9.46; p < 0.001), after adjusting for patient demographics, comorbidities, clinical laboratory values, and baseline KCCQ score, we detected no significant racial differences in patient-reported health status at 3 months (black vs. white difference in KCCQ score: 2.28; 95% CI: -0.84 to 5.41; p = 0.15) or 6 months (black vs. white difference in KCCQ score: 1.91; 95% CI: -1.31 to 5.13; p = 0.24).CONCLUSIONS Compared with white patients, black patients with HF had better patient-reported health status shortly after HF admission but not at 3 or 6 months. Our study failed to show that black patients were disadvantaged with regard to health status after HF hospitalization. (C) 2015 by the American College of Cardiology Foundation.