アルドステロン抗体の使用は,心不全において
Nancy M Albert1, Clyde W Yancy, Li Liang
1Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio, USA. albertn@ccf.org
JAMA
|October 22, 2009
まとめ
ガイドラインで推奨されるアルドステロン抗体療法を受けた資格のある心不全患者の3分の1未満でした. 処方箋の割合はわずかに増加したが,病院での有意な変動は存在し,不適切な使用は低いままだった.
科学分野:
- 心臓病学 心臓病学
- 薬理学 薬理学とは
- 医療サービス 研究 医療サービス
背景:
- アルドステロン抗剤は,静脈機能不全による中度から重度の心不全 (HF) に推奨されます.
- 以前の研究では,適格な患者での使用不足と有害な環境での過剰使用の両方を示しています.
研究 の 目的:
- 入院した心不全患者のアルドステロン抗剤の処方パターンを調べる.
- HF管理ガイドラインと適切性基準に基づいて処方率を評価する.
- アルドステロン抗剤の使用の傾向を時間とともに分析する.
主な方法:
- 2005年1月から2007年12月までの間に入院した43,625人のHF患者の観察分析.
- Get With The Guidelines-HFの品質改善レジストリからのデータを利用しました.
- ガイドラインの基準に基づいて,アルドステロン抗剤の使用の処方率と予測要因を調べた.
主要な成果:
- 退院時にアルドステロン抗生物質を投与した資格のある患者12,565人のうち,わずか32.5%がアルドステロン抗生物質を受けた.
- 処方箋の割合は,研究期間中に28%から34%にわずかに増加しました.
- 病院レベルでの使用の有意な変動 (0%-90.6%) が観察され,不適切な使用は低かった.
結論:
- 入院資格のある心不全患者の3分の1未満は,ガイドラインで推奨されるアルドステロン抗体療法を受けた.
- 禁忌がある患者のアルドステロン抗剤の使用率は低い.
- ガイドラインで推奨される治療法には大きな差異がある.
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