Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.
Medical Intensive Care Unit Brabois, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, Vandoeuvre-les-Nancy, France; Inserm U942, Lariboisière University Hospital, Paris, France.
Int J Cardiol. 2019 Sep 15;291:177-182. doi: 10.1016/j.ijcard.2019.05.043. Epub 2019 May 22.
Previous studies have identified ethnic differences in outcomes after episodes of acute heart failure in natives of Asia as compared to those of Europe. Whether these ethnic differences in outcomes would still exist, years after migration to a different geographical and cultural setting remain unclear. We investigated the one-year mortality after an episode of acute heart failure admission in Ontario residents of South Asian and Chinese descent as compared to the General Population.
We conducted a population-based, retrospective cohort study of adult Ontarions who were hospitalized for AHF between April 1, 2010 and March 31, 2016. Ethnicity was categorized using validated surname-based algorithms. The primary outcome was all-cause one-year mortality. Mortality rates were calculated using the Kaplan-Meier method. The relative hazard of death was assessed using a multivariable Cox proportional hazard model.
Of 82,125 patients, 1287 (1.6%) were Chinese, 1662 (2.0%) were South Asians, and the remaining 79,176 (96.4%) were of the General Population. The risk of mortality was markedly lower amongst South Asians (adjusted HR 0.81, 95% CI [0.73-0.89]) relative to the General Population. There was no statistically significant difference in the risk of mortality between Chinese and the General Population (adjusted HR 1.00 [0.91-1.10]). In addition, guideline-directed medical therapies were associated with similar survival benefit in patients of all three ethnic origins.
We found a lower risk of one-year mortality after acute heart failure hospitalization amongst South Asians compared to Chinese and the General Population, and similar benefit of medical therapy in all three groups. Further studies are needed to explore the etiologies of these ethnic disparities to truly improve outcomes at the population level.
先前的研究已经确定，亚洲原住民与欧洲原住民相比，在急性心力衰竭发作后的结局存在种族差异。在移民到不同的地理和文化环境多年后，这些结局方面的种族差异是否仍然存在尚不清楚。我们调查了南亚和华裔安大略省居民在急性心力衰竭入院后一年内的死亡率，与普通人群进行了比较。
我们进行了一项基于人群的回顾性队列研究，纳入了 2010 年 4 月 1 日至 2016 年 3 月 31 日期间因急性心力衰竭住院的安大略省成年人。种族通过基于姓氏的有效算法进行分类。主要结局是全因一年内的死亡率。使用 Kaplan-Meier 法计算死亡率。使用多变量 Cox 比例风险模型评估死亡的相对风险。
在 82125 名患者中，有 1287 名（1.6%）是中国人，1662 名（2.0%）是南亚人，其余 79176 名（96.4%）是普通人群。与普通人群相比，南亚人的死亡风险明显较低（校正 HR 0.81，95%CI [0.73-0.89]）。中国人与普通人群之间的死亡率风险没有统计学上的显著差异（校正 HR 1.00 [0.91-1.10]）。此外，指南指导的医学治疗与所有三种族裔起源的患者的生存获益相似。
我们发现，与中国人和普通人群相比，南亚人在急性心力衰竭住院后一年内的死亡率风险较低，而且在所有三组人群中，医学治疗的获益相似。需要进一步研究探索这些种族差异的病因，以真正改善人群水平的结局。
