Dickson Victoria Vaughan, Knafl George J, Wald Joyce, Riegel Barbara
New York University College of Nursing, New York, NY (V.V.D.).
University of North Carolina School of Nursing, Chapel Hill, NC (G.J.K.).
J Am Heart Assoc. 2015 Apr 13;4(4):e001561. doi: 10.1161/JAHA.114.001561.
In the United States, the highest prevalence of heart failure (HF) is in blacks followed by whites. Compared with whites, blacks have a higher risk of HF-related morbidity and mortality and HF-related hospitalization. Little research has focused on explaining the reasons for these disparities. The purpose of this study was to examine racial differences in demographic and clinical characteristics in blacks and whites with HF and to determine if these characteristics influenced treatment, or together with treatment, influenced self-care behaviors.
This was a secondary analysis of existing data collected from adults (n=272) with chronic HF enrolled from outpatient sites in the northeastern United States and followed for 6 months. After adjusting for sociodemographic and clinical characteristics within reduced (HFrEF) and preserved ejection fraction (HFpEF) groups, there were 2 significant racial differences in clinical treatment. Blacks with HFrEF were prescribed ACE inhibitors and hydralazine and isosorbide dinitrate (H-ISDN) more often than whites. In the HFpEF group, blacks were taking more medications and were prescribed digoxin and a diuretic when symptomatic. Deficits in HF knowledge and decreased medication adherence, objectively measured, were more prominent in blacks. These racial differences were not explained by sociodemographic or clinical characteristics or clinical treatment variables. Premorbid intellect and the quality of support received contributed to clinical treatment and self-care.
Although few differences in clinical treatment could be attributed solely to race, knowledge about HF and medication adherence is lower in blacks than whites. Further research is needed to explain these observations, which may be targets for future intervention research.
在美国，心力衰竭（HF）患病率最高的是黑人，其次是白人。与白人相比，黑人发生HF相关发病和死亡以及HF相关住院的风险更高。很少有研究专注于解释这些差异的原因。本研究的目的是检查患有HF的黑人和白人在人口统计学和临床特征方面的种族差异，并确定这些特征是否影响治疗，或者与治疗一起是否影响自我护理行为。
这是对从美国东北部门诊招募的患有慢性HF的成年人（n = 272）收集的现有数据进行的二次分析，并随访6个月。在对射血分数降低（HFrEF）和射血分数保留（HFpEF）组内的社会人口统计学和临床特征进行调整后，临床治疗方面存在2个显著的种族差异。HFrEF的黑人比白人更常被处方使用ACE抑制剂以及肼屈嗪和硝酸异山梨酯（H-ISDN）。在HFpEF组中，黑人服用的药物更多，有症状时会被处方使用地高辛和利尿剂。客观测量显示，黑人在HF知识方面存在缺陷且药物依从性降低更为突出。这些种族差异无法用社会人口统计学或临床特征或临床治疗变量来解释。病前智力和所获得支持的质量对临床治疗和自我护理有影响。
尽管临床治疗方面的差异很少能完全归因于种族，但黑人对HF的知识和药物依从性低于白人。需要进一步研究来解释这些观察结果，这可能是未来干预研究的目标。
