Increasing use of single and combination medical therapy in patients hospitalized for acute myocardial infarction in the 21st century - A multinational perspective
Increasing use of single and combination medical therapy in patients hospitalized for acute myocardial infarction in the 21st century - A multinational perspective
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DOI：
10.1001/archinte.167.16.1766
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发表时间：
2007-09-10
影响因子：
--
通讯作者：
Gore, Joel M.
中科院分区：
文献类型：
--
作者：
Goldberg, Robert J.;Spencer, Frederick A.;Gore, Joel M.
背景：目前的实践指南建议急性心肌梗死 (AMI) 的住院幸存者常规使用几种有效的心脏药物。方法：我们对 26 413 名成年男性和女性进行了调查，了解最近 5 年（2000-2005 年）医院使用阿司匹林、β 受体阻滞剂、血管紧张素转换酶 (ACE) 抑制剂、降脂药及其组合的趋势，这些成年男性和女性在 AMI 后出院时没有任何这些治疗的禁忌症。结果：随着时间的推移，ACE 抑制剂、β 受体阻滞剂和他汀类药物治疗的使用量相对稳定地增加，其中降脂治疗的使用量增加尤其显着（从 2000 年的 45% 增加到 2005 年的 85%）。在所有检查期间，阿司匹林的使用率仍然很高（大约 95% 的 AMI 患者）。使用所有 4 种心脏药物治疗的医院幸存者的百分比从 2000 年的 23% 增加到 2005 年的 58%。高龄（≥ 65 岁）、女性、心力衰竭或中风病史以及住院期间发生心房颤动与联合药物治疗使用不足有关。相对相似的因素与 ST 段抬高 AMI 和非 ST 段抬高 AMI 患者联合药物治疗使用不足相关。结论：我们的结果表明，随着时间的推移，在没有这些药物禁忌症的 AMI 住院患者中，联合药物治疗的使用不断增加，令人鼓舞。旨在增加这些疗法的使用的教育工作以及简化药物治疗方案和提高依从率的努力仍然是必要的。
Background: Current practice guidelines recommend the routine use of several effective cardiac medications in hospital survivors of acute myocardial infarction (AMI).Methods: We explored a recent 5-year (2000-2005) trend in hospital use of aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, lipid-lowering agents, and combinations thereof, in 26 413 adult men and women without contraindications to any of these therapies discharged after AMI from hospitals located in 14 countries that were included in the Global Registry of Acute Coronary Events.Results: Relatively steady increases in the use of ACE inhibitors, beta-blockers, and statin therapy were observed over time, with particularly marked increases in the use of lipid-lowering therapy (from 45% in 2000 to 85% in 2005). Aspirin use remained high (by approximately 95% of patients after AMI) during all periods examined. The percentage of hospital survivors treated with all 4 cardiac medications increased from 23% in 2000 to 58% during 2005. Advancing age (>= 65 years), female sex, medical history of heart failure or stroke, and development of atrial fibrillation during hospitalization were associated with underuse of combination medical therapy. Relatively similar factors were associated with the underuse of combination medical therapy in patients with ST-segment elevation AMI and non-ST-segment elevation AMI.Conclusions: Our results suggest encouraging increases over time in the use of combination medical therapy in patients hospitalized with AMI without contraindications to these medications. Educational efforts designed to increase the use of these therapies, as well as efforts to simplify medication regimens and enhance rates of adherence, remain warranted.