Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN, 46202, USA.
Division of Cardiology, University of Chicago, Chicago, IL, USA.
J Racial Ethn Health Disparities. 2024 Dec;11(6):3872-3881. doi: 10.1007/s40615-023-01838-5. Epub 2023 Oct 23.
Black patients with peripartum cardiomyopathy (PPCM) have disproportionately worse outcomes than White patients, possibly related to variable involvement of cardiovascular specialists in their clinical care. We sought to determine whether race was associated with cardiology involvement in clinical care during inpatient admission and whether cardiology involvement in care was associated with higher claims of guideline-directed medical therapy (GDMT) a week after hospital discharge.
Using Optum's de-identified Clinformatics® Data Mart (CDM), we included Black and White patients' first hospital admission for PPCM from 2008 to 2021. Cardiology involvement in clinical care was defined as the receipt of attending care from a cardiovascular specialist during admission. GDMT included beta-blockers (BB) for all patients and triple therapy (BB, angiotensin-responsive medications, and mineralocorticoid receptor antagonists) for non-pregnant patients. Logistic regression was used to determine the associations between cardiology involvement in clinical care during admission and (1) patient race and (2) GDMT prescription, adjusting for age and comorbidities.
Among 668 patients (32.6% Black, 67.4% White, 93.3% commercially insured), there was no significant difference in the odds of cardiology involvement in clinical care by race (aOR: 1.41; 95%CI: 0.87-2.33, P=0.17). Inpatient cardiology care was associated with 2.75 times increased odds of having a prescription claim for GDMT (BB) for White patients (aOR: 2.75; 95%CI 1.50-5.06, P=0.001), and the estimated effect size was similar but not statistically significant for Black patients (aOR: 2.20, 95% CI, 0.84-5.71, P=0.11). The interaction between race and cardiology involvement in clinical care was not statistically significant for the receipt of BB prescription. Among 274 non-pregnant patients with PPCM (37.2% Black, 62.8% White), 5.8% received triple GDMT. Of these, none of the Black patients lacking cardiology care had triple GDMT. However, cardiology involvement in care was not significantly associated with triple GDMT for either race.
Among a commercially insured population within PPCM, race was not associated with cardiology involvement in clinical care during hospitalization. However, cardiology involvement in care was associated with significantly higher odds of prescription claims for BB for only White patients. Additional strategies are needed to support equitable GDMT prescription.
与白人患者相比，患有围产期心肌病（PPCM）的黑人患者的预后明显更差，这可能与心血管专家在他们的临床治疗中参与程度不同有关。我们旨在确定种族是否与住院期间的临床治疗中是否有心脏病学参与有关，以及治疗中是否有心脏病学参与是否与出院后一周内更高的指南指导的药物治疗（GDMT）的主张有关。
我们使用 Optum 的去识别 Clinformatics®Data Mart（CDM），纳入了 2008 年至 2021 年期间首次因 PPCM 住院的黑人及白人患者。临床治疗中的心脏病学参与定义为在住院期间接受心血管专家的主治护理。GDMT 包括所有患者的β受体阻滞剂（BB）和非妊娠患者的三联疗法（BB、血管紧张素反应性药物和盐皮质激素受体拮抗剂）。使用逻辑回归来确定住院期间的临床治疗中是否有心脏病学参与与（1）患者种族和（2）GDMT 处方之间的关联，调整了年龄和合并症。
在 668 名患者（32.6%为黑人，67.4%为白人，93.3%为商业保险）中，种族对临床治疗中是否有心脏病学参与的可能性没有显著差异（优势比：1.41；95%CI：0.87-2.33，P=0.17）。住院期间的心脏病学治疗与白人患者 GDMT（BB）处方的可能性增加 2.75 倍相关（优势比：2.75；95%CI 1.50-5.06，P=0.001），对于黑人患者，估计的效应大小相似，但没有统计学意义（优势比：2.20，95%CI，0.84-5.71，P=0.11）。种族和临床治疗中是否有心脏病学参与之间的交互作用在 BB 处方的接受方面没有统计学意义。在 274 名患有 PPCM 的非妊娠患者中（37.2%为黑人，62.8%为白人），5.8%接受了三联 GDMT。在这些患者中，没有接受过心脏病学治疗的黑人患者没有接受三联 GDMT。然而，无论种族如何，心脏病学治疗的参与都与三联 GDMT 的处方没有显著关联。
在 PPCM 的商业保险人群中，种族与住院期间的临床治疗中是否有心脏病学参与无关。然而，对于白人患者，心脏病学治疗的参与与 BB 处方的可能性显著增加有关。需要采取额外的策略来支持平等的 GDMT 处方。
