PDF(Pubmed)
Abstract：
UNASSIGNED: Transthyretin amyloid cardiomyopathy (ATTR-CM) is associated with significant mortality. The Val122Ile variant, highly prevalent in Black patients, portends poorer survival compared with other ATTR-CM subtypes. Although Val122Ile is biologically more aggressive, the contribution of race and socioeconomic status (SES) to disease outcomes in patients with ATTR-CM is undefined.
UNASSIGNED: The aim of this study was to evaluate the impact of race and SES on clinical outcomes in patients with ATTR-CM.
UNASSIGNED: Patients with ATTR-CM who received care at Johns Hopkins Hospital between 2006 and 2022 were included. SES was assessed using area deprivation index (ADI). Associations of race and ADI with heart failure (HF) hospitalization and/or death were measured using multivariable logistic or Cox proportional hazards models.
UNASSIGNED: Of 282 patients, 225 (80%) were men, and 129 (46%) were Black. Black vs White patients disproportionately constituted the highest ADI (most deprived) category (66% vs 28%; P = 0.004), and Black patients were more likely to have HF hospitalization or death over 5 years compared with White patients (log-rank P < 0.001). Among those with ADI >25, Black patients had a significantly greater hazard of HF hospitalization or death compared with White patients, independent of disease stage at diagnosis (HR: 2.77; 95% CI: 1.45-5.32; P = 0.002).
UNASSIGNED: Black patients with low SES may be at greater risk for underdiagnosis and adverse outcomes compared with White patients. Ongoing efforts are needed to improve outcomes in this subset of patients with ATTR-CM.
UNASSIGNED: The aim of this study was to evaluate the impact of race and SES on clinical outcomes in patients with ATTR-CM.
UNASSIGNED: Patients with ATTR-CM who received care at Johns Hopkins Hospital between 2006 and 2022 were included. SES was assessed using area deprivation index (ADI). Associations of race and ADI with heart failure (HF) hospitalization and/or death were measured using multivariable logistic or Cox proportional hazards models.
UNASSIGNED: Of 282 patients, 225 (80%) were men, and 129 (46%) were Black. Black vs White patients disproportionately constituted the highest ADI (most deprived) category (66% vs 28%; P = 0.004), and Black patients were more likely to have HF hospitalization or death over 5 years compared with White patients (log-rank P < 0.001). Among those with ADI >25, Black patients had a significantly greater hazard of HF hospitalization or death compared with White patients, independent of disease stage at diagnosis (HR: 2.77; 95% CI: 1.45-5.32; P = 0.002).
UNASSIGNED: Black patients with low SES may be at greater risk for underdiagnosis and adverse outcomes compared with White patients. Ongoing efforts are needed to improve outcomes in this subset of patients with ATTR-CM.
摘要：
■转甲状腺素蛋白淀粉样心肌病(ATTR-CM)与显著死亡率相关。Val122Ile变体，在黑人患者中非常普遍，与其他ATTR-CM亚型相比，生存率较差。尽管Val122Ile在生物学上更具攻击性，种族和社会经济地位(SES)对ATTR-CM患者疾病结局的影响尚不明确.
■本研究的目的是评估种族和SES对ATTR-CM患者临床结局的影响。
■在2006年至2022年期间在约翰霍普金斯医院接受治疗的ATTR-CM患者被包括在内。使用面积剥夺指数(ADI)评估SES。使用多变量逻辑或Cox比例风险模型测量种族和ADI与心力衰竭（HF）住院和/或死亡的关联。
■282名患者,225（80％）是男性，129人（46%）为黑人。黑人与白人患者不成比例地构成了最高的ADI（最贫困）类别（66％vs28％；P=0.004），与白人患者相比，黑人患者更有可能在5年内住院或死亡（log-rankP<0.001）。在ADI>25的患者中，与白人患者相比，黑人患者的HF住院或死亡风险明显更大。与诊断时的疾病分期无关（HR：2.77;95％CI：1.45-5.32;P=0.002）。
■与白人患者相比，低SES的黑人患者可能有更大的诊断不足和不良结局的风险。需要持续的努力来改善这一部分ATTR-CM患者的预后。
■本研究的目的是评估种族和SES对ATTR-CM患者临床结局的影响。
■在2006年至2022年期间在约翰霍普金斯医院接受治疗的ATTR-CM患者被包括在内。使用面积剥夺指数(ADI)评估SES。使用多变量逻辑或Cox比例风险模型测量种族和ADI与心力衰竭（HF）住院和/或死亡的关联。
■282名患者,225（80％）是男性，129人（46%）为黑人。黑人与白人患者不成比例地构成了最高的ADI（最贫困）类别（66％vs28％；P=0.004），与白人患者相比，黑人患者更有可能在5年内住院或死亡（log-rankP<0.001）。在ADI>25的患者中，与白人患者相比，黑人患者的HF住院或死亡风险明显更大。与诊断时的疾病分期无关（HR：2.77;95％CI：1.45-5.32;P=0.002）。
■与白人患者相比，低SES的黑人患者可能有更大的诊断不足和不良结局的风险。需要持续的努力来改善这一部分ATTR-CM患者的预后。
