Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure
Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure
复制标题
DOI：
10.1001/jama.298.13.1525
复制
发表时间：
2007-10-03
影响因子：
120.7
通讯作者：
Peterson, Eric D.
中科院分区：
文献类型：
--
作者：
Hernandez, Adrian F.;Fonarow, Gregg C.;Peterson, Eric D.
实践指南推荐植入式心脏转复除颤器（ICD）治疗心力衰竭和左心室射血分数低于30%的患者。性别和种族对符合条件的患者使用ICD的影响尚不清楚。目的探讨ICD治疗的性别和种族差异。设计、设置和患者观察分析13034例在美国心脏协会的心衰质量改善计划中入院的心衰患者，左心室射血分数为30%或更低，并活着出院。患者在2005年1月至2007年6月期间在217家参与医院接受治疗。出院时是否使用ICD治疗或计划中的ICD治疗。结果在符合ICD治疗条件的患者中，4615例（35.4%）在出院时接受了ICD治疗，其中1614例为新ICD， 527例为计划ICD， 2474例为既往ICD。1329名符合条件的黑人女性中有375名（28.2%），2531名白人女性中有754名（29.8%），1977名黑人男性中有660名（33.4%），5403名白人男性中有2356名（43.6%）使用icd （P < 0.001）。在调整患者特征和医院因素后，与白人男性相比，黑人男性使用ICD的调整几率为0.73(95%可信区间，0.60-0.88)，白人女性为0.62(95%可信区间，0.56- 0.71)，黑人女性为0.56（95%可信区间，0.44-0.71）。这种差异不能归因于参与医院的女性和黑人患者的比例，也不能归因于报告左心室射血分数的差异。结论：不到40%的潜在符合条件的心力衰竭住院患者接受了ICD治疗，符合条件的女性和黑人患者的使用率低于白人男性。
Context Practice guidelines recommend implantable cardioverter-defibrillator (ICD) therapy for patients with heart failure and left ventricular ejection fraction of 30% or less. The influence of sex and race on ICD use among eligible patients is unknown.Objective To examine sex and racial differences in the use of ICD therapy.Design, Setting, and Patients Observational analysis of 13 034 patients admitted with heart failure and left ventricular ejection fraction of 30% or less and discharged alive from hospitals in the American Heart Association's Get With the Guidelines Heart Failure quality-improvement program. Patients were treated between January 2005 and June 2007 at 217 participating hospitals.Main Outcome Measures Use of ICD therapy or planned ICD therapy at discharge. Results Among patients eligible for ICD therapy, 4615 (35.4%) had ICD therapy at discharge (1614 with new ICDs, 527 with planned ICDs, and 2474 with prior ICDs). ICDs were used in 375 of 1329 eligible black women (28.2%), 754 of 2531 white women (29.8%), 660 of 1977 black men (33.4%), and 2356 of 5403 white men (43.6%) (P < .001). After adjustment for patient characteristics and hospital factors, the adjusted odds of ICD use were 0.73 (95% confidence interval, 0.60-0.88) for black men, 0.62 (95% confidence interval, 0.56-0.68) for white women, and 0.56 (95% confidence interval, 0.44-0.71) for black women, compared with white men. The differences were not attributable to the proportions of women and black patients at participating hospitals or to differences in the reporting of left ventricular ejection fraction.Conclusions Less than 40% of potentially eligible patients hospitalized for heart failure received ICD therapy, and rates of use were lower among eligible women and black patients than among white men.