Yancy Clyde W, Abraham William T, Albert Nancy M, Clare Robert, Stough Wendy Gattis, Gheorghiade Mihai, Greenberg Barry H, O'Connor Christopher M, She Lilin, Sun Jie Lena, Young James B, Fonarow Gregg C
Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas 75246, USA.
J Am Coll Cardiol. 2008 Apr 29;51(17):1675-84. doi: 10.1016/j.jacc.2008.01.028.
We sought to examine the characteristics, quality of care, and clinical outcomes for a large cohort of African-American patients hospitalized with heart failure (HF) in centers participating in a quality improvement initiative.
Heart failure in African Americans is characterized by variations in natural history, lesser response to evidence-based therapies, and disparate health care. We hypothesized that a performance improvement program will achieve similar adherence to quality measures in African Americans admitted with HF compared with non-African Americans.
The OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) registry-based performance-improvement program includes a pre-specified 10% subgroup with 60- to 90-day follow-up. Data on quality of care measures and outcomes were analyzed for 8,608 African-American patients compared with 38,501 non-African-American patients.
African Americans were significantly younger and more likely to receive evidence-based medications but less likely to receive discharge instructions and smoking cessation counseling. In multivariable analyses, African-American race was an independent predictor of lower in-hospital mortality (odds ratio 0.71; 95% confidence interval 0.57 to 0.87; p < 0.001) but similar hospital length of stay. After multivariable adjustment, post-discharge outcomes were similar for American-American and non-African-American patients, but African-American race was associated with higher angiotensin-converting enzyme inhibitor prescription and left ventricular function assessment; no other HF quality indicators were influenced by race.
In the context of a performance-improvement program, African Americans with HF received similar or better treatment with evidence-based medications, less discharge counseling, had better in-hospital survival, and similar adjusted risk of follow-up death/repeat hospital stay.
我们试图在参与质量改进计划的中心，对一大群因心力衰竭（HF）住院的非裔美国患者的特征、护理质量和临床结局进行研究。
非裔美国人的心力衰竭具有自然病史差异、对循证治疗反应较差以及医疗保健存在差异等特点。我们假设，与非非裔美国人相比，一个绩效改进计划将使因HF入院的非裔美国人在质量指标方面达到相似的依从性。
基于OPTIMIZE-HF（住院心力衰竭患者启动挽救生命治疗的组织计划）登记处的绩效改进计划包括一个预先指定的10%亚组，随访60至90天。对8608名非裔美国患者与38501名非非裔美国患者的护理质量指标和结局数据进行了分析。
非裔美国人明显更年轻，更有可能接受循证药物治疗，但接受出院指导和戒烟咨询的可能性较小。在多变量分析中，非裔美国人种族是住院死亡率较低的独立预测因素（优势比0.71；95%置信区间0.57至0.87；p<0.001），但住院时间相似。多变量调整后，非裔美国患者和非非裔美国患者出院后的结局相似，但非裔美国人种族与更高的血管紧张素转换酶抑制剂处方率和左心室功能评估相关；没有其他HF质量指标受种族影响。
在绩效改进计划的背景下，患有HF 的非裔美国人接受了相似或更好的循证药物治疗，出院咨询较少，住院生存率更高，随访死亡/再次住院的调整风险相似。
