背景：患有围产期心肌病（PPCM）的黑人患者的预后比白人患者差，可能与心血管专家在临床护理中的不同参与有关。我们试图确定住院期间种族是否与心脏病学在临床护理中的参与相关，以及出院后一周心脏病学在护理中的参与是否与更高的指南指导药物治疗（GDMT）要求相关。
方法：使用Optum的去识别的Clinformatics®DataMart(CDM)，我们包括2008年至2021年PPCM首次入院的黑白患者。心脏病学参与临床护理的定义为入院期间接受心血管专科医生的主治护理。GDMT包括所有患者的β受体阻滞剂（BB）和三联疗法（BB，血管紧张素反应药物，和盐皮质激素受体拮抗剂）适用于非妊娠患者。Logistic回归用于确定入院期间心脏病学参与临床护理与（1）患者种族和（2）GDMT处方之间的关联。调整年龄和合并症。
结果：在668例患者中（32.6％的黑人，67.4%白色，93.3％的商业保险），不同种族患者在临床治疗中参与心脏病学的几率无显著差异(aOR:1.41;95CI:0.87-2.33,P=0.17).住院心脏病学护理与白人患者的GDMT（BB）处方索赔的机率增加2.75倍相关（aOR：2.75；95CI1.50-5.06，P=0.001），Black患者的估计效应大小相似，但无统计学意义（aOR：2.20，95％CI，0.84-5.71，P=0.11）。对于接受BB处方，种族和心脏病学参与临床护理之间的相互作用没有统计学意义。在274名非妊娠PPCM患者中（37.2％的黑人，62.8%白色），5.8%获得三倍GDMT。其中,没有心脏病治疗的Black患者均未出现三重GDMT.然而,在任一种族中,心脏病学参与治疗与三重GDMT均无显著相关.
结论：在PPCM内的商业保险人群中，种族与住院期间临床护理中的心脏病学参与无关.然而,仅在白人患者中,心脏病学参与治疗与BB处方索赔的几率显著较高相关.需要其他策略来支持公平的GDMT处方。
BACKGROUND: Black patients with peripartum cardiomyopathy (PPCM) have disproportionately worse outcomes than White patients, possibly related to variable involvement of cardiovascular specialists in their clinical care. We sought to determine whether race was associated with cardiology involvement in clinical care during inpatient admission and whether cardiology involvement in care was associated with higher claims of
guideline-directed medical therapy (GDMT) a week after hospital discharge.
METHODS: Using Optum\'s de-identified Clinformatics® Data Mart (CDM), we included Black and White patients\' first hospital admission for PPCM from 2008 to 2021. Cardiology involvement in clinical care was defined as the receipt of attending care from a cardiovascular specialist during admission. GDMT included beta-blockers (BB) for all patients and triple therapy (BB, angiotensin-responsive medications, and mineralocorticoid receptor antagonists) for non-pregnant patients. Logistic regression was used to determine the associations between cardiology involvement in clinical care during admission and (1) patient race and (2) GDMT prescription, adjusting for age and comorbidities.
RESULTS: Among 668 patients (32.6% Black, 67.4% White, 93.3% commercially insured), there was no significant difference in the odds of cardiology involvement in clinical care by race (aOR: 1.41; 95%CI: 0.87-2.33, P=0.17). Inpatient cardiology care was associated with 2.75 times increased odds of having a prescription claim for GDMT (BB) for White patients (aOR: 2.75; 95%CI 1.50-5.06, P=0.001), and the estimated effect size was similar but not statistically significant for Black patients (aOR: 2.20, 95% CI, 0.84-5.71, P=0.11). The interaction between race and cardiology involvement in clinical care was not statistically significant for the receipt of BB prescription. Among 274 non-pregnant patients with PPCM (37.2% Black, 62.8% White), 5.8% received triple GDMT. Of these, none of the Black patients lacking cardiology care had triple GDMT. However, cardiology involvement in care was not significantly associated with triple GDMT for either race.
CONCLUSIONS: Among a commercially insured population within PPCM, race was not associated with cardiology involvement in clinical care during hospitalization. However, cardiology involvement in care was associated with significantly higher odds of prescription claims for BB for only White patients. Additional strategies are needed to support equitable GDMT prescription.
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