Albosta Michael, Dangl Michael, Vergara-Sanchez Carlos, Ergui Ian, Inestroza Karla, Vincent Louis, Ebner Bertrand, Maning Jennifer, Grant Jelani, Hernandez Rafael, Colombo Rosario
Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida.
Department of Internal Medicine, University of Miami/JFK Medical Center, West Palm Beach, Florida.
Heart Rhythm O2. 2022 Jun 9;3(4):415-421. doi: 10.1016/j.hroo.2022.05.010. eCollection 2022 Aug.
The impact of race and its related social determinants of health on cardiovascular disease outcomes has been well documented. However, limited data exist regarding the association of race with in-hospital outcomes in patients admitted for sinus node dysfunction (SND).
To evaluate whether racial disparities exist in outcomes for patients hospitalized with a primary diagnosis of SND.
The National Inpatient Sample was queried from 2011 to 2018 for relevant ICD-9 and ICD-10 diagnosis and procedure codes. Baseline characteristics and in-hospital outcomes in patients with a primary diagnosis of SND were compared among White and non-White patients. A multivariate logistic regression model was used to adjust for potential confounding factors and statistically significant comorbidities between both cohorts.
We identified 655,139 persons admitted with a primary diagnosis of SND, 520,926 (79.5%) of whom were White. Non-White patients had significantly higher all-cause mortality, length of stay, and total hospital cost. There were lower odds of pacemaker insertion (adjusted odds ratio [aOR] 1.13 [95% confidence interval (CI) 1.11-1.15]), temporary transvenous pacing (aOR 1.15 [95% CI 1.11-1.22]), and cardioversion (aOR 1.50 [95% CI 1.42-1.58]) in non-White patients. A subgroup analysis was performed and non-Hispanic Black race was predictive of a decreased odds of pacemaker insertion, cardioversion/defibrillation, and temporary transvenous pacing.
Significant differences of in-hospital outcomes exist between White and non-White patients with SND. These findings appeared to be primarily driven by disparities in non-Hispanic Black patients. Increased recognition and focused efforts to mitigate these disparities will improve the care of underrepresented populations treated for SND.
种族及其相关的健康社会决定因素对心血管疾病结局的影响已有充分记录。然而，关于种族与因窦房结功能障碍（SND）入院患者的院内结局之间关联的数据有限。
评估以SND为主要诊断住院的患者在结局方面是否存在种族差异。
查询2011年至2018年的全国住院患者样本，获取相关的ICD - 9和ICD - 10诊断及手术编码。比较白种人和非白种人患者中以SND为主要诊断的患者的基线特征和院内结局。使用多因素逻辑回归模型调整两组之间潜在的混杂因素和具有统计学意义的合并症。
我们确定了655139例以SND为主要诊断入院的患者，其中520926例（79.5%）为白种人。非白种人患者的全因死亡率、住院时间和总住院费用显著更高。非白种人患者植入起搏器（调整后的优势比[aOR]为1.13[95%置信区间(CI)为1.11 - 1.15]）、临时经静脉起搏（aOR为1.15[95%CI为1.11 - 1.22]）和心脏复律（aOR为1.50[95%CI为1.42 - 1.58]）的几率较低。进行了亚组分析，非西班牙裔黑人种族预示着植入起搏器、心脏复律/除颤和临时经静脉起搏的几率降低。
SND的白种人和非白种人患者在院内结局方面存在显著差异。这些发现似乎主要由非西班牙裔黑人患者的差异驱动。提高对这些差异的认识并集中努力减轻这些差异，将改善因SND接受治疗的代表性不足人群的护理。
