Missed opportunities in the secondary prevention of myocardial infarction: An assessment of the effects of statin underprescribing on mortality
Missed opportunities in the secondary prevention of myocardial infarction: An assessment of the effects of statin underprescribing on mortality
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DOI：
10.1016/j.ahj.2005.06.034
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发表时间：
2006-05-01
影响因子：
4.8
通讯作者：
Tu, Jack V.
中科院分区：
文献类型：
--
作者：
Austin, Peter C.;Mamdani, Muhammad M.;Tu, Jack V.
背景：他汀类药物对冠心病二级预防的益处已被证实.以前的研究表明，心血管事件风险最高的患者接受他汀类药物的可能性最小。我们探讨了潜在的死亡率降低在人口水平上，可能会导致改善他汀类药物处方的患者最不可能被规定他汀类药物后急性心肌梗死（AMI）的方法模拟分析的详细临床数据为一个基于人口的样本7285 AMI幸存者出院的102家医院之间的1999年4月1日和2001年3月31日在安大略，加拿大已经完成。使用从随机对照试验中获得的估计，我们估计减少3年全因死亡率与改善他汀类药物处方在hospital discharge.Results总体而言，35.6%的患者在出院时接受他汀类药物处方。我们估计，在最不可能接受他汀类药物治疗的患者中增加他汀类药物处方（出院时接受处方的倾向最低的五分位数），从目前的7.8%增加到所有患者的比例（35.6%），可以使安大略每年的AMI死亡率降低83例（占出院后3年内所有AMI后死亡的2.1%）。在安大略，将他汀类药物处方量增加到所有AMI患者的70%，每年可避免312例死亡。在坚持他汀类药物治疗的低利率的因素将减少这些估计值为33和126，respectively.Conclusions适度增加他汀类药物处方的患者最不可能接受一个可以降低后AMI死亡率在人口水平。
Background The benefits - of statins for the secondary prevention of coronary heart disease are well established. Previous research indicates that patients at the greatest risk of cardiovascular events are the least likely to receive statins. We explored the potential reduction in mortality at the population level that could result from improving statin prescribing among patients least likely to be prescribed a statin after acute myocardial infarction (AMI).Methods Simulation analysis of detailed clinical data for a population-based sample of 7285 AMI survivors discharged from 102 hospitals between April 1, 1999, and March 31, 2001 in Ontario, Canada, was done. Using estimates obtained from randomized controlled trials, we estimated the reduction in 3-year all-cause mortality associated with improved statin prescribing at hospital discharge.Results Overall, 35.6% of patients received a statin prescription at hospital discharge. We estimate that increasing statin prescribing among patients least likely to receive them lie, the lowest quintile of propensity to receive a prescription at discharge) from the current rate of 7.8% to the rate among all patients (35.6%) could decrease AMI mortality by 83 deaths in Ontario per year (2.1% of all post-AMI deaths within 3 years of discharge). Increasing statin prescribing to 70% among all patients with AMI could avert 312 deaths per year in Ontario. Factoring in low rates of adherence to statin therapy would reduce these estimates to 33 and 126, respectively.Conclusions Modest increases in statin prescribing for patients least likely to receive one could decrease post-AMI mortality at the population level.