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Takotsubo 心肌病临床结局的种族差异:2006 年至 2018 年全国住院患者样本分析。

Racial Disparities in Clinical Outcomes of Takotsubo Cardiomyopathy: An Analysis of the National Inpatient Sample 2006 to 2018.

机构信息

University of Massachusetts Lowell MA USA.

Washington University in St. Louis, School of Medicine St. Louis MO USA.

出版信息

J Am Heart Assoc. 2024 Aug 6;13(15):e034264. doi: 10.1161/JAHA.124.034264. Epub 2024 Aug 5.

DOI:10.1161/JAHA.124.034264
PMID:39101493
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11964044/
Abstract

BACKGROUND

This study aimed to evaluate the impact of race on in-hospital outcomes of Takotsubo cardiomyopathy using the National Inpatient Sample.

METHODS AND RESULTS

We conducted a retrospective study using data from the National Inpatient Sample database 2006 to 2018. We focused on Takotsubo cardiomyopathy hospitalizations, excluding those with acute coronary syndrome as the primary diagnosis. Two study groups consisted of White patients or Black patients. Univariate and multivariable logistic models evaluated race's effect on death, cardiac arrest, cardiogenic shock, length of stay, while adjusting for potential confounders. The Bayesian model averaging technique was used to further elucidate the factors influencing death within each racial group. Significant differences were observed between the 2 racial groups. Black patients presented at a younger age, had a higher proportion of men, a higher burden of comorbidities, and a lower median household income compared with their White counterparts. In the univariate model, the Black cohort showed an increased risk of cardiac arrest (odds ratio, 1.45 [95% CI, 1.15-1.82]). However, the difference did not reach statistical significance in the multivariable model. Black patients also had a significantly longer hospital stay in both the univariate model (risk ratio, 1.26 [95% CI, 1.22-1.31]) and the multivariable model (risk ratio, 1.06 [95% CI, 1.04-1.07]). No significant difference in all-cause death was observed between the racial groups.

CONCLUSIONS

The outcome differences between 2 racial groups in our study are likely influenced by racial disparities in demographics, comorbidities, and socioeconomic factors. Individualized care based on racial group needs is crucial in clinical practice.

摘要

背景

本研究旨在利用国家住院患者样本评估种族对心尖球形综合征住院患者院内结局的影响。

方法和结果

我们使用 2006 年至 2018 年国家住院患者样本数据库进行了一项回顾性研究。我们关注的是心尖球形综合征住院患者,排除了以急性冠状动脉综合征为主要诊断的患者。两个研究组分别为白人患者或黑人患者。单变量和多变量逻辑模型评估了种族对死亡、心脏骤停、心源性休克、住院时间的影响,同时调整了潜在混杂因素。贝叶斯模型平均技术用于进一步阐明每个种族组内影响死亡的因素。两个种族组之间存在显著差异。与白人患者相比,黑人患者发病年龄更小,男性比例更高,合并症负担更重,家庭中位数收入更低。在单变量模型中,黑人队列的心脏骤停风险增加(比值比,1.45[95%置信区间,1.15-1.82])。然而,多变量模型中差异无统计学意义。黑人患者在单变量模型(风险比,1.26[95%置信区间,1.22-1.31])和多变量模型(风险比,1.06[95%置信区间,1.04-1.07])中的住院时间均显著延长。两组间全因死亡率无显著差异。

结论

我们研究中两个种族组之间的结局差异可能受到人口统计学、合并症和社会经济因素方面的种族差异的影响。基于种族群体需求的个体化护理在临床实践中至关重要。

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本文引用的文献

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Takotsubo syndrome: getting closer to its causes.心肌顿抑综合征:病因研究更近一步。
Cardiovasc Res. 2023 Jul 4;119(7):1480-1494. doi: 10.1093/cvr/cvad053.
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Disparities in Hospital Length of Stay Across Race and Ethnicity Among Patients With Heart Failure.心力衰竭患者的住院时间存在种族和民族差异。
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Takotsubo cardiomyopathy secondary to alcohol withdrawal.酒精戒断继发的应激性心肌病
Glob Cardiol Sci Pract. 2022 Jun 30;2022(1-2):e202206. doi: 10.21542/gcsp.2022.6.
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Takotsubo Syndrome: A Review of Presentation, Diagnosis and Management.应激性心肌病:临床表现、诊断与治疗综述
Clin Med Insights Cardiol. 2022 Jan 4;16:11795468211065782. doi: 10.1177/11795468211065782. eCollection 2022.
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Racial and ethnic disparities in heart failure: current state and future directions.心力衰竭中的种族和民族差异:现状和未来方向。
Curr Opin Cardiol. 2021 May 1;36(3):320-328. doi: 10.1097/HCO.0000000000000855.
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Clinical features and outcomes between African American and Caucasian patients with Takotsubo Syndrome.非裔美国人和白种人Takotsubo 综合征患者的临床特征和结局。
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Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study.射血分数保留的心力衰竭患者的死亡率性别和种族预测因素:ARIC 社区监测研究。
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Circ Heart Fail. 2020 Aug;13(8):e007264. doi: 10.1161/CIRCHEARTFAILURE.120.007264. Epub 2020 Aug 13.
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