Ilonze Onyedika, Free Kendall, Breathett Khadijah
Division of Cardiovascular Medicine, Krannert Cardiovascular Institute, Indiana University Indianapolis, IN, US.
Department of Biofunction Research, Tokyo Medical and Dental University Tokyo, Japan.
Card Fail Rev. 2022 Jul 7;8:e25. doi: 10.15420/cfr.2022.02. eCollection 2022 Jan.
Despite the high prevalence of heart failure among Black and Hispanic populations, patients of colour are frequently under-prescribed guideline-directed medical therapy (GDMT) and American-Indian populations are not well characterised. Clinical inertia, financial toxicity, underrepresentation in trials, non-trustworthy medical systems, bias and structural racism are contributing factors. There is an urgent need to develop evidence-based strategies to increase the uptake of GDMT for heart failure in patients of colour. Postulated strategies include prescribing all GDMT upon first encounter, aggressive outpatient uptitration of GDMT, intervening upon social determinants of health, addressing bias and racism through changing processes or policies that unfairly disadvantage patients of colour, engagement of stakeholders and implementation of national quality improvement programmes.
尽管心力衰竭在黑人和西班牙裔人群中患病率很高，但有色人种患者经常未得到足够的指南指导药物治疗（GDMT），而美国印第安人群体的情况也未得到充分描述。临床惰性、经济毒性、在试验中的代表性不足、不可信赖的医疗系统、偏见和结构性种族主义都是促成因素。迫切需要制定基于证据的策略，以提高有色人种心力衰竭患者对GDMT的接受度。假定的策略包括首次就诊时就开出所有GDMT药物、积极在门诊上调GDMT剂量、干预健康的社会决定因素、通过改变对有色人种患者不公平不利的流程或政策来解决偏见和种族主义、让利益相关者参与以及实施国家质量改进计划。
