背景：射血分数降低的心力衰竭（HFrEF）的指南指导药物治疗（GDMT）的种族差异尚未在社区环境中得到充分记录。
方法：在ARIC监测研究(2005-2014)中，我们检查了出院时GDMT的种族差异，它的时间趋势，以及住院HFrEF患者的预后影响，使用加权回归模型来解释抽样设计。最佳GDMT定义为β受体阻滞剂（BB），盐皮质激素受体拮抗剂（MRA）和ACE抑制剂（ACEI）或血管紧张素II受体阻滞剂（ARB）。可接受的GDMT包括BB，MRA,ACEI/ARB或肼屈嗪加硝酸盐（H-N）。
结果：在16,455（未加权n=3,669）HFrEF病例中，47%是黑人。只有约10％的人使用最佳GDMT出院，黑人的比例高于白人（11.1％vs.8.6%,p<0.001)。在两个种族群体中，BB的使用率均>80％，而黑人更有可能接受ACEI/ARB（62.0％与54.6%）和MRA（18.0%vs.13.8%)比白人，H-N的模式相似(21.8%与10.1%）。两组中最佳GDMT的使用都有减少的趋势，随着ACEI/ARB在白人中的使用显着下降（-2.8％p<0.01），但在两组中均增加了H-N的使用（6.5％和9.2％，p<0.01)。只有ACEI/ARB和BB与较低的1年死亡率相关。
结论：出院时仅约10％的HFrEF患者开出了最佳GDMT，但黑人比白人更为严重。白人的ACEI/ARB使用量下降，而两个种族的H-N使用量增加。GDMT利用率，特别是ACEI/ARB，HFrEF的黑人和白人应该得到改善。
Racial disparities in
guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) have not been fully documented in a community setting.
In the ARIC Surveillance Study (2005-2014), we examined racial differences in GDMT at discharge, its temporal trends, and the prognostic impact among individuals with hospitalized HFrEF, using weighted regression models to account for sampling design. Optimal GDMT was defined as beta blockers (BB), mineralocorticoid receptor antagonist (MRA) and ACE inhibitors (ACEI) or angiotensin II receptor blockers (ARB). Acceptable GDMT included either one of BB, MRA, ACEI/ARB or hydralazine plus nitrates (H-N).
Of 16,455 (unweighted n = 3,669) HFrEF cases, 47% were Black. Only ~ 10% were discharged with optimal GDMT with higher proportion in Black than White individuals (11.1% vs. 8.6%, p < 0.001). BB use was > 80% in both racial groups while Black individuals were more likely to receive ACEI/ARB (62.0% vs. 54.6%) and MRA (18.0% vs. 13.8%) than Whites, with a similar pattern for H-N (21.8% vs. 10.1%). There was a trend of decreasing use of optimal GDMT in both groups, with significant decline of ACEI/ARB use in Whites (- 2.8% p < 0.01) but increasing H-N use in both groups (+ 6.5% and + 9.2%, p < 0.01). Only ACEI/ARB and BB were associated with lower 1-year mortality.
Optimal GDMT was prescribed in only ~ 10% of HFrEF patients at discharge but was more so in Black than White individuals. ACEI/ARB use declined in Whites while H-N use increased in both races. GDMT utilization, particularly ACEI/ARB, should be improved in Black and Whites individuals with HFrEF.
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