Trends in Use of Implantable Cardioverter-Defibrillator Therapy Among Patients Hospitalized for Heart Failure Have the Previously Observed Sex and Racial Disparities Changed Over Time?
Trends in Use of Implantable Cardioverter-Defibrillator Therapy Among Patients Hospitalized for Heart Failure Have the Previously Observed Sex and Racial Disparities Changed Over Time?
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DOI：
10.1161/circulationaha.111.066605
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发表时间：
2012-03-06
期刊：
影响因子：
37.8
通讯作者：
Peterson, Eric D.
中科院分区：
文献类型：
--
作者：
Al-Khatib, Sana M.;Hellkamp, Anne S.;Peterson, Eric D.
背景-先前的研究表明，植入型心脏复律除颤器(ICD)作为一级预防的使用率很低，特别是在妇女和黑人中。ICD治疗的总体使用和使用差异的变化程度尚不清楚。方法和结果-我们检查了11880名有心衰史和左心室射血分数=65岁的独特患者，并在2005年1月至2009年12月期间参加了GET With the Guidestions-心力衰竭(GWTG-HF)计划。我们确定了总体人口、性别和种族群体按年使用ICD的比率。从2005年到2007年，ICD的总体使用率从30.2%增加到42.4%，然后在2008年到2009年保持不变。在调整了潜在的混杂因素后，2005年至2007年期间，在整个研究人群中，ICD的使用显著增加(优势比，1.28；95%可信区间，每年1.11-1.48；P=0.0008)；黑人女性(优势比，1.82；95%可信区间，每年1.28-2.58；P=0.0008)，白人女性(优势比，1.3；95%可信区间，每年1.06-1.59；P=0.010)，黑人男性(优势比，1.54；白人男性(优势比为1.25；95%可信区间为每年1.06-1.48；P=0.0072)。结论：在GWTG-HF质量改进计划中，随着时间的推移，在所有性别和种族群体中，ICD治疗的使用都显著增加。在研究结束时，先前描述的ICD使用方面的种族差异不再存在；然而，性别差异仍然存在。(发行量。2012；125：1094-1101。)
Background-Prior studies have demonstrated low use of implantable cardioverter defibrillators (ICDs) as primary prevention, particularly among women and blacks. The degree to which the overall use of ICD therapy and disparities in use have changed is unclear.Methods and Results-We examined 11 880 unique patients with a history of heart failure and left ventricular ejection fraction = 65 years old and enrolled in the Get With the Guidelines-Heart Failure (GWTG-HF) program from January 2005 through December 2009. We determined the rate of ICD use by year for the overall population and for sex and race groups. From 2005 to 2007, overall ICD use increased from 30.2% to 42.4% and then remained unchanged in 2008 to 2009. After adjustment for potential confounders, ICD use increased significantly in the overall study population during 2005 to 2007 (odds ratio, 1.28; 95% confidence interval, 1.11-1.48 per year; P=0.0008) and in black women (odds ratio, 1.82; 95% confidence interval, 1.28-2.58 per year; P=0.0008), white women (odds ratio, 1.30; 95% confidence interval, 1.06-1.59 per year; P=0.010), black men (odds ratio, 1.54; 95% confidence interval, 1.19-1.99 per year; P=0.0009), and white men (odds ratio, 1.25; 95% confidence interval, 1.06-1.48 per year; P=0.0072). The increase in ICD use was greatest among blacks.Conclusions-In the GWTG-HF quality improvement program, a significant increase in ICD therapy use was observed over time in all sex and race groups. The previously described racial disparities in ICD use were no longer present by the end of the study period; however, sex differences persisted. (Circulation. 2012;125:1094-1101.)