Differences in quality of anticoagulation care delivery according to ethnoracial group in the United States: A scoping review.

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Thrombosis and Thrombolysis Pub Date : 2024-08-01 Epub Date: 2024-05-11 DOI:10.1007/s11239-024-02991-2
Sara R Vazquez, Naomi Y Yates, Craig J Beavers, Darren M Triller, Mary M McFarland
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Abstract

Anticoagulation therapy is standard for conditions like atrial fibrillation, venous thromboembolism, and valvular heart disease, yet it is unclear if there are ethnoracial disparities in its quality and delivery in the United States. For this scoping review, electronic databases were searched for publications between January 1, 2011 - March 30, 2022. Eligible studies included all study designs, any setting within the United States, patients prescribed anticoagulation for any indication, outcomes reported for ≥ 2 distinct ethnoracial groups. The following four research questions were explored: Do ethnoracial differences exist in 1) access to guideline-based anticoagulation therapy, 2) quality of anticoagulation therapy management, 3) clinical outcomes related to anticoagulation care, 4) humanistic/educational outcomes related to anticoagulation therapy. A total of 5374 studies were screened, 570 studies received full-text review, and 96 studies were analyzed. The largest mapped focus was patients' access to guideline-based anticoagulation therapy (88/96 articles, 91.7%). Seventy-eight articles made statistical outcomes comparisons among ethnoracial groups. Across all four research questions, 79 articles demonstrated favorable outcomes for White patients compared to non-White patients, 38 articles showed no difference between White and non-White groups, and 8 favored non-White groups (the total exceeds the 78 articles with statistical outcomes as many articles reported multiple outcomes). Disparities disadvantaging non-White patients were most pronounced in access to guideline-based anticoagulation therapy (43/66 articles analyzed) and quality of anticoagulation management (19/21 articles analyzed). Although treatment guidelines do not differentiate anticoagulant therapy by ethnoracial group, this scoping review found consistently favorable outcomes for White patients over non-White patients in the domains of access to anticoagulation therapy for guideline-based indications and quality of anticoagulation therapy management. No differences among groups were noted in clinical outcomes, and very few studies assessed humanistic or educational outcomes.

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美国不同人种抗凝治疗质量的差异:范围综述。
抗凝疗法是治疗心房颤动、静脉血栓栓塞症和瓣膜性心脏病等疾病的标准疗法,但在美国,抗凝疗法的质量和实施是否存在种族差异尚不清楚。本次范围界定综述在电子数据库中检索了 2011 年 1 月 1 日至 2022 年 3 月 30 日期间的出版物。符合条件的研究包括所有研究设计、美国境内的任何环境、任何适应症的抗凝处方患者、≥ 2 个不同种族群体的结果报告。我们探讨了以下四个研究问题:在以下方面是否存在种族差异:1)获得基于指南的抗凝疗法的机会;2)抗凝疗法管理的质量;3)与抗凝护理相关的临床结果;4)与抗凝疗法相关的人文/教育结果。共筛选出 5374 项研究,对 570 项研究进行了全文审阅,并对 96 项研究进行了分析。最大的映射焦点是患者获得基于指南的抗凝疗法(88/96 篇,91.7%)。78篇文章对不同种族群体进行了统计结果比较。在所有四个研究问题中,79 篇文章显示白人患者的治疗效果优于非白人患者,38 篇文章显示白人和非白人群体之间没有差异,8 篇文章显示非白人群体的治疗效果优于白人群体(由于许多文章报告了多种治疗效果,因此统计结果总数超过了 78 篇文章)。非白人患者在获得基于指南的抗凝治疗(分析了 43/66 篇文章)和抗凝管理质量(分析了 19/21 篇文章)方面处于不利地位的差异最为明显。尽管治疗指南并未按种族群体区分抗凝疗法,但本范围界定综述发现,在根据指南适应症获得抗凝疗法和抗凝疗法管理质量方面,白人患者的疗效始终优于非白人患者。在临床治疗效果方面,各群体之间没有发现差异,只有极少数研究对人文或教育效果进行了评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.20
自引率
0.00%
发文量
112
审稿时长
4-8 weeks
期刊介绍: The Journal of Thrombosis and Thrombolysis is a long-awaited resource for contemporary cardiologists, hematologists, vascular medicine specialists and clinician-scientists actively involved in treatment decisions and clinical investigation of thrombotic disorders involving the cardiovascular and cerebrovascular systems. The principal focus of the Journal centers on the pathobiology of thrombosis and vascular disorders and the use of anticoagulants, platelet antagonists, cell-based therapies and interventions in scientific investigation, clinical-translational research and patient care. The Journal will publish original work which emphasizes the interface between fundamental scientific principles and clinical investigation, stimulating an interdisciplinary and scholarly dialogue in thrombosis and vascular science. Published works will also define platforms for translational research, drug development, clinical trials and patient-directed applications. The Journal of Thrombosis and Thrombolysis'' integrated format will expand the reader''s knowledge base and provide important insights for both the investigation and direct clinical application of the most rapidly growing fields in medicine-thrombosis and vascular science.
期刊最新文献
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