Tertulien Tarryn, Bush Kelvin, Jackson Larry R, Essien Utibe R, Eberly Lauren
Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Division of Cardiology, San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
Curr Treat Options Cardiovasc Med. 2023 Dec;25(12):771-791. doi: 10.1007/s11936-023-01025-z. Epub 2023 Dec 20.
Sudden cardiac arrest is associated with high morbidity and mortality. Despite having a disproportionate burden of sudden cardiac death (SCD), rates of primary and secondary prevention of SCD with implantable cardioverter-defibrillator (ICD) therapy are lower among eligible racially minoritized patients. This review highlights the racial and ethnic disparities in ICD utilization, associated barriers to ICD care, and proposed interventions to improve equitable ICD uptake.
Racially minoritized populations are disproportionately eligible for ICD therapy but are less likely to see cardiac specialists, be counseled on ICD therapy, and ultimately undergo ICD implantation, fueling disparate outcomes. Racial disparities in ICD utilization are multifactorial, with contributions at the patient, provider, health system, and structural/societal level.
Racial and ethnic disparities have been demonstrated in preventing SCD with ICD use. Proposed strategies to mitigate these disparities must prioritize care delivery and access to care for racially minoritized patients, increase the diversification of clinical and implementation trial participants and the healthcare workforce, and center reparative justice frameworks to rectify a long history of racial injustice.
心脏骤停与高发病率和死亡率相关。尽管在心脏性猝死（SCD）方面负担不成比例，但在符合条件的少数族裔患者中，植入式心脏复律除颤器（ICD）治疗对SCD的一级和二级预防率较低。本综述强调了ICD使用方面的种族和族裔差异、ICD治疗的相关障碍以及为提高ICD公平使用率而提出的干预措施。
少数族裔人群接受ICD治疗的比例过高，但他们看心脏专科医生、接受ICD治疗咨询并最终接受ICD植入的可能性较小，这导致了不同的结果。ICD使用方面的种族差异是多因素的，在患者、提供者、卫生系统以及结构/社会层面都有影响。
在使用ICD预防SCD方面已证实存在种族和族裔差异。为减轻这些差异而提出的策略必须优先考虑为少数族裔患者提供护理和获得护理的机会，增加临床和实施试验参与者以及医疗保健劳动力的多样性，并以修复性司法框架为核心，以纠正长期存在的种族不公正历史。
