《2010年CCS心脏衰竭的诊断和管理更新准则》内容预览：

    Few places in the world possess the racial diversity that is present inCanada. Based on the Statistics Canada 2006 Census

   (1), the visibleminority population surpassed five million, reaching 16.2% of thepopulation. Of these, the four most common minorities in Canadainclude Chinese, South Asian, black and Aboriginal groups. Together,these four groups comprise over 88% of visible minorities in Canadaand, as such, the focus of the present section will primarily be on them.In addition, most of the data currently published in this arena has beenobservational in nature. However, apart from ethnocultural data, mostof the published data suggest that there are more similarities than dif-ferences among these populations and Caucasians with respect to diag-nosis or treatment of HF. To understand and manage a person’s illness, itis necessary to appreciate the effects of the person’s culture, experiencesand social environment. Hope and morale may be crucial to patients’adaptation and maintenance of involvement in the management oftheir condition

     (2), and gaps in communications as a result of ethno-cultural differences between the patients and the health care workersmay have a detrimental effect on patients’ adaptation to their illness.To date, there have been very few published population-based epi-demiological studies of HF in countries outside North America andwestern Europe. It is generally believed that rheumatic heart disease isa major cause of HF in sub-Saharan Africa, and certain parts of Asiaand South America. Hypertension is an important cause of HF in Asiaand in the African and African American populations, whereasChagas disease is a cause of HF in subjects from South America

    (3).However, because these regions constantly undergo epidemiologicaland economic transitions, the epidemiology of HF is likely to increas-ingly resemble that of the western world. The large international case-controlled INTERHEART study
 
    (4) has demonstrated that the impactof conventional and potentially preventable risk factors on the risk ofmyocardial infarctions is consistent across different geographicalregions and different ethnic groups. This implies that similar preven-tive measures for myocardial infarction and the subsequent develop-ment of HF may be applicable to different ethnic populations indifferent geographical locations. There is little evidence to indicatethat the criteria used to diagnose HF substantially differs among ethnicpopulations. For example, a recent study from the United States (US)

    (5) demonstrated that the diagnostic performance of N-terminal pro-B-type natriuretic peptide is similar in African Americans and non-African Americans. With respect to the treatment of patients with HF,relatively few large-scale randomized controlled intervention trials inHF have included regions outside Europe and the US. Smaller clinicaltrials (6,7) have shown the effectiveness of ACE inhibitors and beta-blockers in HF patients from Africa and Asia. Given the fundamentalnature of the derangements in HF, our current approach, includingneurohormonal blockade and the appropriate use of devices, will likelybe effective, although dosages and responses may differ slightly amongethnic groups.

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