Decade-long changes in the use of combination evidence-based medical therapy at discharge for patients surviving acute myocardial infarction
Decade-long changes in the use of combination evidence-based medical therapy at discharge for patients surviving acute myocardial infarction
复制标题
DOI：
10.1016/j.ahj.2004.11.005
复制
发表时间：
2005-10-01
影响因子：
4.8
通讯作者：
Goldberg, RJ
中科院分区：
文献类型：
--
作者：
Spencer, FA;Lessard, D;Goldberg, RJ
背景 目前的实践指南建议对急性心肌梗死 (AMI) 的医院幸存者常规使用几种有效的心脏药物。我们基于人群的研究的目的是描述 AMI 后从所有大伍斯特（马萨诸塞州）大都会医院出院的患者中阿司匹林、β 受体阻滞剂、血管紧张素转换酶抑制剂、降脂药及其组合的使用趋势（1990-2001 年）。 方法 研究样本包括 7 年内从所有大伍斯特医院出院的 5965 名各个年龄段的成年男性和女性。 1990 年至 2001 年间的结果。 结果 尽管随着时间的推移观察到每种有效心脏药物的使用量持续增加，但血管紧张素转换酶抑制剂（相对增加 168%）和降脂药（相对增加 1086%）的使用相对显着增加。随着时间的推移，有效心脏药物组合的使用也大幅增加。 1990 年至 2001 年间，接受 3 种以上心脏药物治疗的医院幸存者百分比从 12.9% 增加到 74.0%。高龄、女性、住院期间心绞痛、高血压或心力衰竭病史、初始非 Q 波 MI 的存在以及首次住院期间心房颤动的发生均与联合药物治疗使用不足独立相关。 结论 目前的结果表明，在过去十年中，AMI 住院患者的医疗管理取得了显着改善。然而，针对临床医生并旨在改善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 suggest routine use of several effective cardiac medications in hospital survivors of acute myocardial infarction (AMI). The objectives of our population-based study were to describe decade-long trends (1990-2001) in the use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, lipid-lowering agents, and combinations thereof, in patients discharged from all metropolitan Worcester (Mass) hospitals after AMI.Methods The study sample consisted of 5965 adult men and women of all ages discharged after AMI from all greater Worcester hospitals in 7 annual periods between 1990 and 2001.Results Although consistent increases in the use of each of the effective cardiac medications examined were observed over time, particularly marked relative increases in the use of angiotensin-converting enzyme inhibitors (168% relative increase) and lipid-lowering agents (1086% relative increase) were noted. Use of combinations of effective cardiac medications also increased substantially over time. Between 1990 and 2001, the percentage of hospital survivors treated with >= 3 cardiac medications increased from 12.9% to 74.0%. Advancing age, female sex, history of angina, hypertension, or heart failure during hospitalization, presence of an initial non-Q wave MI, and development of atrial fibrillation during the index hospitalization were independently associated with underuse of combination medical therapy.Conclusions The present results suggest considerable improvements over the last decade in the medical management of patients hospitalized with AMI. Educational efforts, however, aimed at clinicians and designed to improve use of these therapies, as well as efforts to simplify medication regimens and enhance rates of adherence, remain warranted.