女性和黑人男性接受挽救生命的心力衰竭治疗的可能性较小
劳拉·威廉姆森，美国心脏协会沙巴足球体育平台
Access to potentially lifesaving heart failure treatments has increased in recent years, 但女性和黑人男性接受这种待遇的可能性仍然要小得多, 新的研究表明.
The study, 周三发表在《沙巴足球体育平台》上, found racial and gender disparities in who receives advanced treatments for a type of heart failure called heart failure with reduced ejection fraction, or HFrEF.
"Among women and Black men, there is clearly a disparity," said lead study author Dr. Amresh Hanchate, a professor of social sciences and health policy at Wake Forest University School of Medicine in Winston Salem, North Carolina. "But we were surprised to find no difference in the procedures for Black women compared to white women and Hispanic women. 这种差异主要存在于黑人男性中."
当心脏肌肉不能泵出足够的血液时，就会发生HFrEF, 使其难以完成日常任务. 也被称为收缩期心力衰竭, 诊断时左心室, 心腔心脏四个腔中最大的一个, can't push more than 40% of the blood in the chamber out to the rest of the body.
左心室辅助装置, or LVAD, is a mechanical pump that is surgically implanted to help the heart pump better. 这可能是一个短期的解决办法, 有时被称为“移植的桥梁”,“如果需要心脏移植. 但有些人可能会永久使用这种泵, 尤其是如果他们不适合移植的话.
研究人员分析了汇总普查, medical and survey data from 2010 to 2018 from 19 states representing 67% of the U.S. adult population, including 85% of the Hispanic and 70% of the Black populations. Among 114.年龄在35岁到84岁之间的成年人估计有100万.900万人患有心力衰竭. Of the nearly 70,000 with HFrEF, 约44%是女性, 近30%是黑人，约10%是西班牙裔.
2010年至2018年, 黑人的心脏移植率和左心室辅助器使用率稳步上升, 西班牙和白人成人HFrEF. 但是女性的治疗率只有男性的三分之一. 尽管黑人男性的HFrEF率更高, their treatment rates were significantly lower than those for Hispanic or white men.
Women with HFrEF were 72% less likely to receive an LVAD than men and had a 62% lower rate of heart transplant. Black men were 25% less likely to be given an LVAD and had a 46% lower heart transplant rate than their white peers.
Hanchate said prior studies on treatment disparities included all people with heart failure, 不仅仅是那些最需要先进疗法的人. 只关注那些HFrEF患者, he said, allowed his team to arrive at more precise calculations of how treatments were being allocated. But the investigation did not address why women and Black men weren't being treated equitably.
"I'm hoping that this study will provoke people into asking these questions," he said.
Bias among health care professionals who evaluate and refer patients for treatment likely plays a role, said Dr. Monica Colvin, medical director of heart transplants and a professor of medicine in the cardiology division at the University of Michigan in Ann Arbor. “内隐偏见是一种可能. The evaluation for candidacy for advanced therapies can be prone to subjectivity."
科尔文引用了《沙巴足球体育平台》杂志2020年的一项研究 JAMA网络开放 in which members of a national heart failure organization were presented with similar clinical data for two sets of patients. 患者之间唯一显著的差异是他们的种族. The survey responses showed Black patients were less likely to be referred for heart transplants than their white peers and more likely to be recommended for an LVAD.
这可以用偏见来解释," said Colvin, 谁没有参与2020年的研究或新的研究. “这没有明显的医学依据."
Other factors, such as how much support a person has at home to help use devices such as LVADs or to successfully recover from transplants, 也可能使转诊过程偏向男性, Colvin said. “女性通常是家庭中的照顾者, but they are sometimes perceived to be lacking in social support for themselves."
Yet a 2019 study 血液循环:显示心力衰竭 女性也同样有可能活下来 心脏移植手术.
"We have to standardize the referral process to remove subjectivity and provide support for those who need it," Colvin said.
一项后续研究 published in JAHA in 2021 found Black people are less likely to get needed heart transplants and more likely to die when they get them.
Failure to refer people for treatment could result in lower survival rates and worse quality of life, Hanchate said, 强调在选拔过程中消除偏见的必要性.
"We need to have guidelines that are much more clear for primary care providers and cardiologists about who should be referred for these procedures and do it in a way that does not implicitly or systematically exclude eligible patients," he said.