心力衰竭伴左心室收缩功能障碍患者使用双心室起搏器的社会经济和种族差异。

Socioeconomic and ethnic disparities in the use of biventricular pacemakers in heart failure patients with left ventricular systolic dysfunction.

机构信息

Harvard University, Cambridge, Massachusetts, USA.

出版信息

Ethn Dis. 2013 Summer;23(3):275-80.

Abstract

OBJECTIVES

Biventricular pacing (BiV) is an important therapy for symptomatic heart failure (HF) patients with reduced left ventricular (LV) ejection fraction (EF). The aim of our study was to determine if ethnic disparities in use of BiV in HF patients with LV systolic dysfunction are independent of socioeconomic status.

DESIGN, SETTING, PARTICIPANTS: Data collected on 32,911 hospitalized HF patients with EF < or = 35% from Pennsylvania hospitals that implanted BiVs in 2004 and 2005 were submitted to the Pennsylvania Health Care Cost Containment Council. Multivariate analysis used patient clinical, insurance and hospital characteristics to identify independent predictors of BiV in symptomatic HF patitents with EF < or = 35%.

MAIN OUTCOME MEASURES

Use of BiV in symptomatic HF patients with LV systolic dysfunction.

RESULTS

BiV was implanted in 2,065/ 15,861 (13%) Whites, 182/3107 (5.9%) African Americans and 175/1301 (13.5%) others. Older age, male sex, intraventricular conduction delay and prior myocardial infarction or bypass surgery (all P < .001) were positively associated with BiV while diabetes (P < .01), higher EF or higher Mediqual Atlas severity score (both P < .0001) were negatively associated with BiV. Adjusting for these variables, African American ethnicity (odds ratio [OR] .56, 95% CI,.46-68, P < .0001) and poverty, comparing the poorest quintile to other quintiles (OR .86, 95% CI, .76-98, P < .02), were associated with less BiV, independent of fixed effects of hospitals (P < .0001) and a positive association of BiV with Medicare vs Medicaid (P < .01).

CONCLUSIONS

In a large statewide sample, BiV was implanted less frequently in African Americans and in lower-income patients, independent of clinical, hospital and insurance characteristics, identifying persisting disparities in use of advanced cardiac technology.

摘要

目的

双心室起搏（BiV）是治疗射血分数降低的有症状心力衰竭（HF）患者的重要疗法。我们的研究目的是确定 LV 收缩功能障碍的 HF 患者中，BiV 的使用是否存在种族差异，而这种差异是否独立于社会经济地位。

设计、地点和参与者：宾夕法尼亚州医院 2004 年和 2005 年植入 BiV 的 HF 患者中，EF<或=35%的 32911 例住院患者的数据提交给宾夕法尼亚州医疗保健成本控制委员会。多变量分析采用患者临床、保险和医院特征，确定 EF<或=35%的有症状 HF 患者中 BiV 的独立预测因素。

主要观察指标

有症状 LV 收缩功能障碍的 HF 患者中 BiV 的使用。

结果

BiV 植入 15861 例白人患者中的 2065 例（13%），3107 例非裔美国人中的 182 例（5.9%）和 1301 例其他族裔中的 175 例（13.5%）。年龄较大、男性、室内传导延迟、既往心肌梗死或旁路手术（均 P<0.001）与 BiV 呈正相关，而糖尿病（P<0.01）、EF 较高或 Mediqual Atlas 严重程度评分较高（均 P<0.0001）与 BiV 呈负相关。在调整这些变量后，非裔美国人的种族（比值比[OR]0.56，95%可信区间，0.46-0.68，P<0.0001）和贫困（与最贫困五分位数相比，其他五分位数的 OR 为 0.86，95%可信区间，0.76-0.98，P<0.02）与 BiV 使用率较低相关，独立于医院固定效应（P<0.0001），BiV 与医疗保险相比，Medicaid 的比值比为 1.15（95%可信区间，1.06-1.24，P<0.01）。