Management of ventricular arrhythmias in diverse populations in California
Management of ventricular arrhythmias in diverse populations in California
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DOI：
10.1067/mhj.2002.125500
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发表时间：
2002-09-01
影响因子：
4.8
通讯作者：
Hlatky, MA
中科院分区：
文献类型：
--
作者：
Alexander, M;Baker, L;Hlatky, MA
背景：在黑人患者中，冠状动脉造影术和血运重建术的使用率低于预期。目前还不确定是否使用其他心脏手术也不同，根据种族和民族，以及是否结果受到影响。方法我们分析了出院摘要从所有非联邦医院在加州的患者住院的初步诊断室性心动过速或室颤之间的1992年和1994年。我们比较了死亡率和使用电生理研究（EPS）和植入式心律转复除颤器（ICID）程序根据种族和ethnicationsofpatient.Results 8713例室性心动过速或心室颤动，29%（n = 2508）有随后的EPS程序，和9%（n = 8 - 18）有ICD植入。在控制了潜在的混杂因素后，我们发现黑人患者比白色患者接受EPS（比值比0.72，CI 0.56-0.92）或ICID植入（比值比0.39，CI 0.25-0.60）的可能性显著降低。即使在控制了多种混杂风险因素后，黑人首次入院后存活出院的患者在接下来的一年中的死亡率也高于白色患者（风险比1.18，CI 1.03-1.36）。EPS和ICD程序的使用也受到其他几个因素的显着影响，最显着的现场程序的可用性，但也由年龄，性别和保险status.Conclusions在一个大的人口的患者住院治疗室性心律失常，黑人有显着较低的利用率为EPS和ICD程序和较高的后续死亡率。
Background The use of coronary angiography and revascularization is lower than expected among black patients. It is uncertain whether use of other cardiac procedures also varies according to race and ethnicity and whether outcomes are affected.Methods We analyzed discharge abstracts from all nonfederal hospitals in California of patients hospitalized for a primary diagnosis of ventricular tachycardia or ventricular fibrillation between 1992 and 1994. We compared mortality rates and use of electrophysiologic study (EPS) and implantable cardioverter-defibrillator (ICID) procedures according to the race and ethnicity of the patient.Results Among 8713 patients admitted with ventricular tachycardia or ventricular fibrillation, 29% (n = 2508) had a subsequent EPS procedure, and 9% (n = 8 18) had an ICD implanted. After controlling for potential confounding factors, we found that black patients Were significantly less likely than white patients to undergo EPS (odds ratio 0.72, Cl 0.56-0.92) or ICID implantation (odds ratio 0.39, Cl 0.25-0.60). Blacks discharged alive from the initial hospital admission had higher mortality rates over the next year than white patients, even after controlling for multiple confounding risk factors (risk ratio 1.18, Cl 1.03-1.36). The use of EPS and ICD procedures was also significantly affected by several other factors, most notably by on-site procedure availability but also by age, sex, and insurance status.Conclusions in a large population of patients hospitalized for ventricular arrhythmia, blacks had significantly lower rates of utilization for EPS and ICD procedures and higher subsequent mortality rates.