McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.
Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York.
Am J Cardiol. 2023 Jun 1;196:79-86. doi: 10.1016/j.amjcard.2023.02.030. Epub 2023 Apr 4.
Many patients hospitalized for heart failure (HF) do not receive recommended follow-up cardiology care, and non-White patients are less likely to receive follow-up than White patients. Poor HF management may be particularly problematic in patients with cancer because cardiovascular co-morbidity can delay cancer treatments. Therefore, we sought to describe outpatient cardiology care patterns in patients with cancer hospitalized for HF and to determine if receipt of follow-up varied by race/ethnicity. SEER (Surveillance, Epidemiology, and End Results) data from 2007 to 2013 linked to Medicare claims from 2006 to 2014 were used. We included patients aged 66+ years with breast, prostate, or colorectal cancer, and preexisting HF. Patients with cancer were matched to patients in a noncancer cohort that included individuals with HF and no cancer. The primary outcome was receipt of an outpatient, face-to-face cardiologist visit within 30 days of HF hospitalization. We compared follow-up rates between cancer and noncancer cohorts, and stratified analyses by race/ethnicity. A total of 2,356 patients with cancer and 2,362 patients without cancer were included. Overall, 43% of patients with cancer and 42% of patients without cancer received cardiologist follow-up (p = 0.30). After multivariable adjustment, White patients were 15% more likely to receive cardiology follow-up than Black patients (95% confidence interval [CI] 1.02 to 1.30). Black patients with cancer were 41% (95% CI 1.11 to 1.78) and Asian patients with cancer were 66% (95% CI 1.11 to 2.49) more likely to visit a cardiologist than their noncancer counterparts. In conclusion, less than half of patients with cancer hospitalized for HF received recommended follow-up with a cardiologist, and significant race-related differences in cardiology follow-up exist. Future studies should investigate the reasons for these differences.
许多因心力衰竭（HF）住院的患者未接受推荐的心脏病学随访，而非白人患者接受随访的可能性低于白人患者。心血管合并症可能会延迟癌症治疗，因此，癌症合并 HF 的患者的 HF 管理可能特别成问题。因此，我们旨在描述因 HF 住院的癌症患者的门诊心脏病学治疗模式，并确定随访是否因种族/民族而异。我们使用了 2007 年至 2013 年的 SEER（监测、流行病学和最终结果）数据，并与 2006 年至 2014 年的 Medicare 索赔数据进行了关联。我们纳入了年龄在 66 岁及以上的患有乳腺癌、前列腺癌或结直肠癌且存在先前 HF 的患者。将癌症患者与非癌症队列中的患者相匹配，该队列包括患有 HF 但无癌症的个体。主要结局是在 HF 住院后 30 天内接受门诊面对面心脏病专家就诊。我们比较了癌症和非癌症队列之间的随访率，并按种族/民族进行了分层分析。共有 2356 名癌症患者和 2362 名无癌症患者被纳入。总体而言，43%的癌症患者和 42%的无癌症患者接受了心脏病专家的随访（p=0.30）。在多变量调整后，白人患者接受心脏病学随访的可能性比黑人患者高 15%（95%置信区间 [CI] 1.02 至 1.30）。黑人癌症患者接受心脏病专家就诊的可能性比非癌症患者高 41%（95% CI 1.11 至 1.78），而亚洲癌症患者接受心脏病专家就诊的可能性比非癌症患者高 66%（95% CI 1.11 至 2.49）。总之，不到一半因 HF 住院的癌症患者接受了推荐的心脏病专家随访，并且在心脏病学随访方面存在显著的种族相关差异。未来的研究应调查这些差异的原因。
