Quality of care of patients with acute myocardial infarction in Bulgaria: a cross-sectional study
Quality of care of patients with acute myocardial infarction in Bulgaria: a cross-sectional study
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DOI：
10.1186/1472-6963-9-15
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发表时间：
2009-01-26
影响因子：
2.8
通讯作者：
Geraedts, Max
中科院分区：
文献类型：
--
作者：
Ganova-Iolovska, Milka;Kalinov, Krassimir;Geraedts, Max
背景：心血管疾病是保加利亚的主要死亡原因。由于保加利亚和其他欧洲国家之间死亡率的显著差异，我们假定在急性心肌梗死（AMI）的管理方面存在明显差异，并且对循证治疗的利用不足。为了确定保加利亚AMI患者的护理质量，我们分析了当前治疗的适当性及其与患者特征的关系。方法：我们进行了一项描述性横断面研究，使用回顾性收集的医学图表数据。我们纳入了2004年9月1日至12月31日期间在保加利亚斯塔拉扎戈拉地区居住和住院的所有急性心肌梗塞患者。社会经济地位的调查是在一个结构化的病人访谈框架内进行的。我们使用Fisher精确概率的卡方检验来分析患者的院前延迟年龄、性别和社会经济地位之间的关系，并使用学生独立样本t检验来检验关于平均值的假设。结果：134例AMI患者（平均年龄64.6岁，标准差13.2,66%男性），7%在59分钟内就诊，44%在症状出现4小时内就诊。肝素的使用率为98%。在最初的24小时内，82%的患者使用了ASS， 73%的患者使用了β受体阻滞剂。出院时阿司匹林、受体阻滞剂、血管紧张素转换酶抑制剂或ar受体阻滞剂和他汀类药物分别占85%、79%、66%和43%。32%符合条件的st段抬高患者接受了静脉纤溶治疗。经皮冠状动脉介入治疗4例患者在AMI后1个月内。与患者居住地相关的医院位置和前往医院的交通方式并不影响症状出现到开始住院治疗之间的时间延迟。在研究区域，延迟与年龄和受教育程度都有关系。结论：保加利亚急性心肌梗死患者的实际护理质量与循证建议相去甚远。需要进一步研究和改善保健服务，以减轻保加利亚心血管疾病的负担。
Background: Cardiovascular diseases are the major cause of death in Bulgaria. Because of notable differences in mortality rates between Bulgaria and other European countries, we presume a tangible difference in the management of acute myocardial infarction (AMI) and an underutilization of evidence-based treatments. In order to determine the quality of care of patients with AMI in Bulgaria, we analyzed the appropriateness of current treatments and their relation to patient characteristics.Methods: We performed a descriptive cross-sectional study, using retrospectively collected data from medical charts. We included all patients with AMI, residing and admitted to hospitals in the region of Stara Zagora, Bulgaria, between September 1st and December 31st, 2004. Socioeconomic status was surveyed within the framework of a structured patient interview. We used chi-square tests with Fisher's exact probabilities to analyze the relationship between prehospital time delay age, sex, and socio-economic status of the patients and Student's independent samples t-tests to check hypotheses about means.Results: From 134 patients with AMI (mean age 64.6, SD 13.2, 66% male), 7% presented to a hospital within 59 minutes, and 44% within 4 hours of symptoms onset. The use of Heparin was 98%. In the first 24 hours, ASS was administrated in 82% and beta-Blockers in 73% of the cases. At discharge Aspirin, beta-Blockers, Angiotensin Converting Enzyme Inhibitors or AR-Blockers and Statins were used in 85%, 79%, 66%, and 43% of cases respectively. Intravenous fibrinolysis was applied in 32% of the eligible patients with ST-segment elevation. Percutaneous coronary interventions were applied in four patients within the first month after AMI. Hospital location in relation to a patient's place of residence and manner of transportation to hospital did not influence the time delay between the onset of symptoms to the start of hospital treatment. In the study region, a relation between time delay and both age and education level was observed.Conclusion: The actual quality of care of patients with AMI in Bulgaria lies far from the evidencebased recommendations. Additional research and improvements in health services are needed to reduce the burden of cardiovascular disease in Bulgaria.