【学术2015-96】AF治疗存在种族和性别差异

　　【学术2015-96】AF治疗存在种族和性别差异

　　2015-04-18长城国际心脏病学会议长城国际心脏病学会议

　　长城国际心脏病学会议

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　　（英文原文）Race andGender Related Differences in Care for Patients Newly Diagnosed with AtrialFibrillation

　　Background Atrial fibrillation (AF) is associated withincreased risk of stroke and death. Uniform utilization of appropriatetherapies for AF may help reduce those risks.

　　Objectives We sought to determine whether significant raceand gender differences exist in the treatment of newly diagnosed AF amongMedicare beneficiaries.

　　Methods We used administrative encounter data forMedicare beneficiaries to identify patients with newly diagnosed AF during2010-2011. Services received after initial AF diagnosis were catalogued,including visits with a cardiologist or electrophysiologist, catheter ablationprocedures, and use of oral anticoagulants, rate control agents, andantiarrhythmic drugs.

　　Results Overall, 517,941 patients met study criteria, ofwhich 452,986 (87%) were white, 36,425 (7%) were black, and 28,530 (6%) wereHispanic. Males comprised 41% of the cohort. In multivariate analysis, therewere statistically significant differences by both race and gender in the useof AF-related services, with white patients and male patients receiving themost care. The most notable disparities were for catheter ablation (Hispanic vswhite: Adjusted Hazard Ratio [AHR] 0.70, 95% CI 0.63-0.79, p<0.001; femalevs male: AHR 0.65, 95% CI 0.63-0.68, p<0.001) and receipt of oralanticoagulation (black vs white: AHR 0.94, 95% CI 0.92-0.95, p<0.001; Hispanicvs white: AHR 0.94, 95% CI 0.93-0.97, p<0.001; female vs male: AHR 0.93, 95%CI 0.93-0.94, p<0.001).

　　Conclusions Race and gender appearto have significant impact on the health care provided to this cohort ofMedicare patients diagnosed with AF. Possible explanations include racialdifferences in access, patient preferences, treatment bias, and unmeasuredclinical characteristics.

　　来源：ACC CV News Digest（April 11，2015）

　　AF治疗存在种族和性别差异（中文摘要）

　　近日一项队列研究表明，种族和性别似乎对房颤（AF）患者的治疗有显著影响，，其可能的原因包括在获得治疗、患者偏好、治疗偏见以及未检测的临床特征方面存在种族差异。

　　AF与卒中和死亡危险增加相关，而正确的治疗或有助于减少这些危险。本研究采用Medicare受益人管理数据以找出2010-2011年被新诊断为AF的患者，并根据在心脏病科医师或电生理专家处就诊情况、导管消融术以及口服抗凝药、控制心率的药物和抗心律失常药的使用情况进行治疗分类。

　　结果显示，共517941例患者符合研究纳入标准，白人、黑人和西班牙裔所占比例分别为87%、7%和6%；男性占41%。多变量分析显示，在接受AF相关的医疗服务方面，种族和性别间存在显著差异，白人和男性患者接受的治疗最多。最显著的差异是导管消融术（西班牙裔对比白人：校正后HR：0.70，P<0.001；女性对比男性：校正后HR：0.65，P<0.001）和口服抗凝药的使用（黑人对比白人：校正后HR：0.94，P<0.001；西班牙裔对比白人：校正后HR：0.94，P<0.001；女性对比男性：校正后HR：0.93，P<0.001）。