病院での二次予防薬の服用率の変動と品質への影響
Robin Mathews1, William Wang2, Lisa A Kaltenbach2
1Duke Clinical Research Institute, Durham, NC (R.M., W.W., L.A.K., L.T., E.D.P., T.Y.W.) robin.mathews@duke.edu.
Circulation
|February 2, 2018
まとめ
心筋梗塞 (MI) の後の治療薬の病院での使用は様々で,患者の治療結果に影響します. 病院での従事率の上昇は 長期的な心血管疾患の予防と関連しています
科学分野:
- 心臓病科
- 医療サービス研究
- 薬理学について
背景:
- 急性心筋梗塞 (MI) の後の長期的な結果を改善するために,薬の服用が不可欠です.
- MI患者の治療中の米国の病院では 薬の服用量に大きな違いがあります
- 患者のアウトカムは,心筋梗塞後の病院レベルの薬剤耐用率と相関すると仮定されています.
研究 の 目的:
- 急性心筋梗塞 (MI) の後の米国の病院間の薬剤遵守の変動を調査する.
- 病院での投与順序と心臓発作患者の長期的 kardiovascular 結果との関連を決定する.
主な方法:
- 347の病院 (ACTION Registry-GWTG) から心筋梗塞で退院した19704人のMedicareのデータを利用した.
- Medicare Part Dデータを用いて退院後90日以内に治療した日数の>80%の割合で定義される.
- 2年間の主要な心血管不良事件 (MACE) を様々な病院で比較するためにコックスの比例リスクモデルを使用した.
主要な成果:
- 合計90日間の服用率:β阻害剤 (68%),スタチン (63%),ACE阻害剤/ARB (64%),チエノピリジン (72%).
- すべての薬剤クラスで,病院レベルでの着信率の有意な変動が観察されました.
- 最も高いアデレンス四分位数を持つ病院は,最も低い四分位数と比較して,調整された2年間のMACEリスク (aHR,0. 88) と調整された死亡率または再入院率 (aHR,0. 90) を低めた.
結論:
- 退院後の二次予防薬の使用は,米国の病院によって大きく異なります.
- 病院での治療の順守は2年間の心血管疾患の悪影響と逆に関連しています.
- 入院患者と外来患者の間のケア調整が改善されれば,治療の順守と心臓発作後の患者のアウトカムが改善される可能性があります.
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