Association of early follow-up after acute myocardial infarction with higher rates of medication use
Association of early follow-up after acute myocardial infarction with higher rates of medication use
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DOI：
10.1001/archinte.168.5.485
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发表时间：
2008-03-10
影响因子：
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通讯作者：
Masoudi, Frederick A.
中科院分区：
文献类型：
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作者：
Daugherty, Stacie L.;Ho, P. Michael;Masoudi, Frederick A.
背景资料：早期门诊随访后，急性心肌梗死（AMI）的建议，在指南中，但其关系使用循证therapies is unknown.Methods：我们评估了1516例AMI住院患者的多中心前瞻性登记评估结果后心肌梗死：事件和恢复登记。早期随访定义为出院后1个月内由初级保健医生或心脏病专家进行的患者报告访视。主要结局是合格患者在6个月时使用阿司匹林、β受体阻滞剂、血管紧张素转换酶抑制剂和他汀类药物。多变量分析评估了早期随访与6个月时药物使用之间的相关性，并根据患者和临床特征进行了调整。二次分析比较了药物使用在6个月的患者接受合作随访从一个单一的供应商与那些接受后续从两个供应商types.Results：在队列中，34%的报告没有门诊随访在一个月后出院。两个随访组出院时，适当候选人的药物处方率相似。与未接受早期随访的患者相比，接受早期随访的患者更有可能在6个月时使用β受体阻滞剂（80.1% vs 71.3%; P = .001）、阿司匹林（82.9% vs 77.1%; P = .01）或他汀类药物（75.9% vs 68.6%; P = .005）。在多变量分析中，早期随访与β受体阻滞剂使用之间存在持续关系（风险比，1.08; 95%置信区间，1.02-1.15）。在二次分析中，他汀类药物的使用在接受协作随访的患者中更高（风险比，1.11; 95%置信区间，1.01-1.22）。结论：AMI后早期门诊随访和协作随访与更高的循证药物使用率相关。虽然进一步的研究应该评估这种关系是否是因果关系，但这些结果支持当前指南对AMI后随访的建议。
Background: Early outpatient follow-up after acute myocardial infarction (AMI) is recommended in guidelines, but its relationship with the use of evidence-based therapies is unknown.Methods: We evaluated 1516 patients hospitalized with AMI from the multicenter Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery registry. Early follow-up was defined as patient-reported visits with a primary care physician or cardiologist within 1 month after discharge. The primary outcomes were use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and statins in eligible patients at 6 months. Multivariable analyses assessed the association between early follow-up and medication use at 6 months, adjusting for patient and clinical characteristics. Secondary analyses compared medication use at 6 months for patients receiving collaborative follow-up from a single provider vs those receiving follow-up from both provider types.Results: Among the cohort, 34% reported no outpatient follow-up during the month following discharge. Rates of medication prescription among appropriate candidates were similar at hospital discharge for both follow-up groups. Compared with those not receiving early follow-up, those receiving early follow-up were more likely to be prescribed beta-blockers (80.1% vs 71.3%; P = .001), aspirin (82.9% vs 77.1%; P = .01), or statins (75.9% vs 68.6%; P = .005) at 6 months. In multivariable analyses, a persistent relationship remained between early followup and beta-blocker use (risk ratio, 1.08; 95% confidence interval, 1.02-1.15). In secondary analyses, statin use was higher in patients receiving collaborative follow-up (risk ratio, 1.11; 95% confidence interval, 1.01-1.22).Conclusions: Early outpatient follow-up and collaborative follow-up after AMI is associated with higher rates of evidence-based medication use. Although further studies should assess whether this relationship is causal, these results support current guideline recommendations for follow-up after AMI.