Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease.
Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease.
复制标题
遵守糖尿病患者和缺血性心脏病患者的心脏保护药物和死亡率。
DOI：
10.1186/1471-2261-6-48
复制
发表时间：
2006-12-15
影响因子：
2.1
通讯作者：
Rumsfeld JS
中科院分区：
文献类型：
--
作者：
Ho PM;Magid DJ;Masoudi FA;McClure DL;Rumsfeld JS
糖尿病和缺血性心脏病（IHD）患者发生不良心脏结局的风险较高。临床实践指南建议使用多种心脏保护药物以减少复发事件。我们评估了糖尿病和IHD患者心脏保护药物依从性与死亡率之间的关系。在一项3,998例糖尿病合并IHD患者的回顾性队列研究中，我们评估了ACE抑制剂或血管紧张素受体阻滞剂、β受体阻滞剂和他汀类药物的使用情况。心脏保护药物的接受基于已填写的处方。药物依从性计算为已填写处方的覆盖天数比例（PDC）。关注的主要结局是全因死亡率。大多数患者（92.8%）接受了至少1种心脏保护药物。与未接受任何药物治疗的患者相比，接受任何药物治疗的患者的未校正死亡率较低（7.9% vs. 11.5%; p = 0.03）。在多变量分析中，接受任何心脏保护药物仍与较低的全因死亡率相关（OR 0.65; 95%CI 0.43-0.99）。在接受心脏保护药物治疗的患者中，大多数（80.3%）为依从性（PDC ≥ 0.80）。依从性患者的未校正死亡率较低（6.7% vs. 12.1%; p < 0.01）。在多变量分析中，与不依从相比，药物依从性与较低的全因死亡率（OR 0.52; 95%CI 0.39-0.69）相关。相比之下，接受心脏保护药物治疗的患者与未接受任何药物治疗的患者相比，死亡率无差异（OR 1.01; 95% CI 0.64-1.61）。总之，药物依从性与糖尿病和IHD患者的结局改善相关。需要质量改进干预措施来提高药物依从性，以便患者最大限度地受益于心脏保护药物。
Patients with diabetes and ischemic heart disease (IHD) are at high risk for adverse cardiac outcomes. Clinical practice guidelines recommend multiple cardioprotective medications to reduce recurrent events. We evaluated the association between cardioprotective medication adherence and mortality among patients with diabetes and IHD. In a retrospective cohort study of 3,998 patients with diabetes and IHD, we evaluated use of ACE inhibitors or angiotensin receptor blockers, β-blockers, and statin medications. Receipt of cardioprotective medications was based on filled prescriptions. Medication adherence was calculated as the proportion of days covered (PDC) for filled prescriptions. The primary outcome of interest was all-cause mortality. The majority of patients (92.8%) received at least 1 cardioprotective medication. Patients receiving any medications had lower unadjusted mortality rates compared to patients not receiving any medications (7.9% vs. 11.5%; p = 0.03). In multivariable analysis, receipt of any cardioprotective medication remained associated with lower all-cause mortality (OR 0.65; 95% CI 0.43–0.99). Among patients receiving cardioprotective medications, the majority (80.3%) were adherent (PDC ≥ 0.80). Adherent patients had lower unadjusted mortality rates (6.7% vs. 12.1%; p < 0.01). In multivariable analysis, medication adherence remained associated with lower all-cause mortality (OR 0.52; 95% CI 0.39–0.69) compared to non-adherence. In contrast, there was no mortality difference between patients receiving cardioprotective medications who were non-adherent compared to patients not receiving any medications (OR 1.01; 95% CI 0.64–1.61). In conclusion, medication adherence is associated with improved outcomes among patients with diabetes and IHD. Quality improvement interventions are needed to increase medication adherence in order for patients to maximize the benefit of cardioprotective medications.