University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma City, OK 73104, USA.
J Natl Med Assoc. 2012 May-Jun;104(5-6):287-98. doi: 10.1016/s0027-9684(15)30156-5.
Race is associated with differences in use of guideline-recommended therapies for patients with heart failure (HF).
To evaluate whether a practice-based performance improvement intervention is associated with similar improvements in evidence-based care for black, white, and race-undocumented patients.
IMPROVE HF is a longitudinal evaluation of a performance improvement intervention on use of evidence-based therapies for outpatients with HF or prior myocardial infarction and left ventricular ejection fraction less than or equal to 35%. Data were available for 7605 patients. Changes in use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, aldosterone antagonist, cardiac resynchronization therapy, implantable cardioverter-defibrillator therapy, anticoagulant for atrial fibrillation, and HF education were analyzed by patient race (black, white, or undocumented/missing). Multivariate analyses identified variables independently associated with changes in each therapy.
There were 686 black patients (9.0%) and 3238 white patients (42.6%), and race was undocumented for 3537 (46.5%). Baseline use of B-blockers and aldosterone antagonists was significantly higher in black patients than in the other 2 groups, and use of aldosterone antagonists and HF education was higher among black patients at 24 months. Postintervention use of 4 of 7 therapies increased equitably for the 3 groups, and treatment rates were similar between black and white patients for 5 of 7 individual quality measures. Improvements in care were independent of race.
These findings offer some indication that race-based differences in delivery of evidence-based HF care may be decreasing in outpatient cardiology practices. Application of clinical decision support and performance feedback may facilitate equitable improvements in HF care in outpatient settings regardless of patient race.
NCT00303979, wwwv.clinicaltrials.gov.
种族与心力衰竭（HF）患者指南推荐疗法的使用差异有关。
评估基于实践的绩效改进干预措施是否与黑种人、白种人和未记录种族患者的循证护理的类似改善相关。
改善 HF 是对一项绩效改进干预措施的纵向评估，该干预措施针对门诊 HF 或既往心肌梗死且左心室射血分数（LVEF）小于或等于 35%的患者，使用基于证据的治疗方法。共有 7605 名患者的数据可用。通过患者种族（黑人、白人或未记录/缺失）分析血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、β受体阻滞剂、醛固酮拮抗剂、心脏再同步治疗、植入式心脏复律除颤器治疗、心房颤动抗凝和 HF 教育的使用变化。多变量分析确定了与每种治疗方法变化相关的独立变量。
有 686 名黑人患者（9.0%）和 3238 名白人患者（42.6%），3537 名（46.5%）患者种族未记录。黑人患者的β受体阻滞剂和醛固酮拮抗剂的基线使用率明显高于其他两组，且黑人患者在 24 个月时的醛固酮拮抗剂和 HF 教育使用率较高。7 种治疗方法中有 4 种在 3 组中平等增加，5 种治疗方案中黑人和白人患者的治疗率相似。护理质量的改善与种族无关。
这些发现表明，在门诊心脏病学实践中，基于种族的心力衰竭循证护理提供方式的差异可能正在减少。应用临床决策支持和绩效反馈可能会促进门诊环境中无论患者种族如何，HF 护理的公平改善。
NCT00303979，wwwv.clinicaltrials.gov。
