Evidence-based pharmacotherapy after myocardial infarction in France: Adherence-associated factors and relationship with 30-month mortality and rehospitalization
Evidence-based pharmacotherapy after myocardial infarction in France: Adherence-associated factors and relationship with 30-month mortality and rehospitalization
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DOI：
10.1016/j.acvd.2010.05.003
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发表时间：
2010-06-01
影响因子：
3
通讯作者：
Allemand, Hubert
中科院分区：
文献类型：
--
作者：
Tuppin, Philippe;Neumann, Anke;Allemand, Hubert
背景- 国际指南建议在心肌梗死（MI）后长期使用β受体阻滞剂、阿司匹林/氯吡格雷、他汀类药物和血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（ACEIs/ARB）联合循证治疗（EBT），以降低心脏病发病率和死亡率。- 评估MI住院后的药物依从性及其与死亡率和急性冠状动脉综合征再入院的关系。- 对2006年上半年在法国因急性心肌梗死入院且6个月后仍存活的患者进行了30个月的观察性随访。从国家出院数据库和门诊药物报销数据库中获得的数据与一般健康保险计划覆盖的所有患者（占法国人口的70%）相关联。结果β受体阻滞剂、他汀类药物、ACEI/ARB、阿司匹林/氯吡格雷和EBT联合用药的依从性分别为32.0%、24.0%、22.7%、18.3%和50.0%。对于低收入者来说，随着年龄超过74岁、患有合并症和全面医疗保险，EBT的依从性显着下降。在首次住院之前或期间，既往EBT使用和支架植入增加了依从性。在调整患者特征和管理后，预先使用每类药物均可降低死亡率。MI后不坚持EBT会增加死亡率和再入院率（危险比= 1.43，P <0.0001）。- MI后，不依从EBT与全因死亡率和急性冠脉综合征再入院率显著增加相关。在依从性差的患者群体中，应制定具有成本效益的依从性改善策略。(C)2010年Elsevier Masson SAS。All rights reserved.
Background. - International guidelines recommend long-term use of evidence-based treatment (EBT) combining beta-blockers, aspirin/clopidogrel, statins and either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEls/ARBs) after a myocardial infarction (MI), to reduce cardiac morbidity and mortality.Aims. - To evaluate medication adherence after hospital admission for MI and the relationship with mortality and readmission for acute coronary syndrome.Methods. - Observational, 30-month follow-up of patients admitted for acute MI in France in the first half of 2006 and still alive 6 months later. Data from the national hospital discharge database and the outpatient medications reimbursement database were linked for all patients covered by the general health insurance scheme (70% of the French population). A patient was considered as adherent when the proportion of days covered by a filled prescription was greater than 80%.Results The proportion of nonadherent patients was 32.0% for beta-blockers, 24.0% for statins, 22.7% for ACEls/ARBs, 18.3% for aspirin/clopidogrel and 50.0% for combined EBT. Adherence to EBT was decreased significantly by age greater than 74 years, comorbidities and full healthcare coverage for low earners. Prior EBT use and stent implantation, before or during index hospitalization, increased adherence. After adjustment for patient characteristics and management, prior use of each class decreased mortality. Nonadherence to EBT after MI increased mortality and readmission (hazard ratio = 1.43, P < 0.0001).Conclusion. - After MI, nonadherence to EBT is associated with a marked increase in all-cause mortality and readmission for acute coronary syndrome. Cost-effective strategies for adherence improvement should be developed among patient groups with poor adherence. (C) 2010 Elsevier Masson SAS. All rights reserved.