Aspirin use is low among United States outpatients with coronary artery disease.
Aspirin use is low among United States outpatients with coronary artery disease.
复制标题
美国冠状动脉疾病门诊患者中阿司匹林的使用率较低。
DOI：
10.1161/01.cir.101.10.1097
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发表时间：
2000
期刊：
影响因子：
37.8
通讯作者：
Stafford,RS
中科院分区：
文献类型：
--
作者：
Stafford,RS
背景--本研究的目的是评估全国范围内冠心病患者使用阿司匹林的趋势和模式。虽然有强有力的证据表明，使用阿司匹林可以降低冠心病患者的死亡和复发风险，但目前全国范围内阿司匹林的使用模式尚不清楚。方法和结果--我们使用了1980至1996年全国门诊医疗保健调查的数据。这些调查提供了具有全国代表性的医生在患者到医生办公室就诊期间的活动样本。我们评估了10 942例冠心病患者去看心脏病医生和初级保健医生时，阿司匹林作为一种新的或持续的药物的报告。我们评估了1980年至1996年阿司匹林的使用趋势，并使用Logistic回归分析确定了1993年至1996年阿司匹林使用的独立预测因素。没有报告禁忌症的冠心病患者在门诊中使用阿司匹林的比例从1980年的5.0%上升到1996年的26.2%。20世纪90年代初出现了大幅增长。在1993年至1996年，阿司匹林使用的独立预测因素是男性患者性别(29%对女性21%)、患者年龄80岁(28%对17%≥80岁)和高脂血症(45%对非高脂血症患者24%；所有比较P<；0.001)。心脏病医生(37%)报告使用阿司匹林的可能性高于内科医生(20%)、家庭医生(18%)或全科医生(11%；P<；0.001)。在我们使用Logistic回归控制了潜在的混杂因素后，这些影响仍然存在。结论--尽管冠心病患者的阿司匹林使用量显著增加，但它仍然不是最理想的。阿司匹林使用率低和使用变化表明有必要更好地将临床建议转化为实践。
Background—The goal of the present study was to assess national trends and patterns of aspirin use among outpatients with coronary artery disease. Although there is strong evidence that the use of aspirin reduces the risk of death and recurrent events in patients with coronary artery disease, current national patterns of aspirin use are unknown.Methods and Results—We used data from the 1980 to 1996 National Ambulatory Medical Care Surveys. These surveys provide a nationally representative sample of physician activities during patient visits to physician offices. We evaluated the report of aspirin as a new or continuing medication in 10 942 visits to cardiologists and primary care physicians by patients with coronary artery disease. We evaluated trends in the use of aspirin for 1980 to 1996 and used logistic regression to identify independent predictors of aspirin use for 1993 to 1996. Aspirin use in outpatient visits by persons with coronary artery disease without reported contraindications increased from 5.0% in 1980 to 26.2% in 1996. Large increases occurred in the early 1990s. Independent predictors of aspirin use in 1993 to 1996 were male patient gender (29% versus 21% for females), patient age of <80 years (28% versus 17% for age of ≥80 years), and presence of hyperlipidemia (45% versus 24% for patients without hyperlipidemia; all comparisonsP<0.001). Cardiologists (37%) were more likely to report aspirin use than were internists (20%), family physicians (18%), or general practitioners (11%;P<0.001). These effects persisted after we controlled for potential confounders with the use of logistic regression.Conclusions—Although aspirin use in patients with coronary artery disease has increased dramatically, it remains suboptimum. Low rates of aspirin use and variations in use suggest a need to better translate clinical recommendations into practice.