Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Europace. 2023 Jun 2;25(6). doi: 10.1093/europace/euad148.
To date, potential differences in outcomes for immigrants and non-immigrants with a cardiac resynchronization therapy (CRT), in a European setting, remain underutilized and unknown. Hence, we examined the efficacy of CRT measured by heart failure (HF)-related hospitalizations and all-cause mortality among immigrants and non-immigrants.
All immigrants and non-immigrants who underwent first-time CRT implantation in Denmark (2000-2017) were identified from nationwide registries and followed for up to 5 years. Differences in HF related hospitalizations and all-cause mortality were evaluated by Cox regression analyses. From 2000 to 2017, 369 of 10 741 (3.4%) immigrants compared with 7855 of 223 509 (3.5%) non-immigrants with a HF diagnosis underwent CRT implantation. The origins of the immigrants were Europe (61.2%), Middle East (20.1%), Asia-Pacific (11.9%), Africa (3.5%), and America (3.3%). We found similar high uptake of HF guideline-directed pharmacotherapy before and after CRT and a consistent reduction in HF-related hospitalizations the year before vs. the year after CRT (61% vs. 39% for immigrants and 57% vs. 35% for non-immigrants). No overall difference in 5-year mortality among immigrants and non-immigrants was seen after CRT [24.1% and 25.8%, respectively, P-value = 0.50, hazard ratio (HR) = 1.2, 95% confidence interval (CI): 0.8-1.7]. However, immigrants of Middle Eastern origin had a higher mortality rate (HR = 2.2, 95% CI: 1.2-4.1) compared with non-immigrants. Cardiovascular causes were responsible for the majority of deaths irrespective of immigration status (56.7% and 63.9%, respectively).
No overall differences in efficacy of CRT in improving outcomes between immigrants and non-immigrants were identified. Although numbers were low, a higher mortality rate among immigrants of Middle Eastern origin was identified compared with non-immigrants.
迄今为止，在欧洲环境下，移民和非移民接受心脏再同步治疗（CRT）的结果差异仍然未被充分认识和了解。因此，我们研究了 CRT 对心力衰竭（HF）相关住院和全因死亡率的疗效在移民和非移民中的差异。
通过全国性登记册确定了丹麦在 2000 年至 2017 年间首次接受 CRT 植入的所有移民和非移民，并对其进行了长达 5 年的随访。通过 Cox 回归分析评估 HF 相关住院和全因死亡率的差异。2000 年至 2017 年期间，369 例（3.4%）HF 诊断移民与 7855 例（3.5%）非移民接受了 CRT 植入。移民的来源地为欧洲（61.2%）、中东（20.1%）、亚太地区（11.9%）、非洲（3.5%）和美洲（3.3%）。我们发现 HF 指南指导的药物治疗在 CRT 前后的使用率都很高，且 CRT 前一年与后一年相比 HF 相关住院率显著降低（61%比 39%，移民；57%比 35%，非移民）。在 CRT 后，移民和非移民的 5 年死亡率之间没有总体差异[分别为 24.1%和 25.8%，P 值=0.50，风险比（HR）=1.2，95%置信区间（CI）：0.8-1.7]。然而，中东裔移民的死亡率更高（HR=2.2，95%CI：1.2-4.1）。无论移民身份如何，心血管原因导致的死亡占大多数（分别为 56.7%和 63.9%）。
在改善 CRT 结局方面，移民和非移民之间的疗效无总体差异。尽管数量较少，但与非移民相比，中东裔移民的死亡率更高。
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