在急性心肌梗塞后早出院的演变中存在国际差异
Padma Kaul1, L Kristin Newby, Yuling Fu
1University of Alberta, Edmonton, Alberta, Canada. pkaul@ualberta.ca
Lancet (London, England)
|February 21, 2004
概括
低风险急性心肌梗塞患者的早期出院是可行的. 然而,国际上存在显著的差异,欧洲国家在提前放电率方面表现出最大的改善潜力.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
背景情况:
- 低风险急性心肌梗塞 (AMI) 患者的早期出院是安全的和可行的.
- 之前的研究表明,在提前出院时,不良事件的风险不会增加.
- 该研究调查了国际上对AMI患者早期出院实践的采用.
研究的目的:
- 评估哪些国家对符合条件的AMI患者使用提前出院的程度.
- 为了确定不同国家的AMI患者住院时间的变化.
- 评估AMI患者长时间住院的经济影响.
主要方法:
- 分析了来自GUSTO-I,GUSTO-III和ASSENT-2试验 (1990-1998) 的54174名患者.
- 包括来自美国,加拿大,澳大利亚,新西兰,比利时,法国,德国,西班牙和波兰的患者.
- 提前出院的定义是入院后4天内活着;评估可能不必要的住院日.
主要成果:
- 与非欧洲国家相比,欧洲国家住院时间明显长.
- 符合条件的AMI患者的早期出院率在美国,加拿大,澳大利亚和新西兰保持在40%以下.
- 在比利时,法国,德国,西班牙和波兰,提前放学率非常低 (<2%).
- 在ASSENT-2试验中,每100名患者的潜在不必要的住院日数从65天 (新西兰) 到839天 (德国) 不等.
结论:
- 在AMI患者住院时间的模式中,国际上仍然存在显著的差异.
- 在全球范围内,对于优化低风险AMI患者的早期出院,存在巨大的潜力.
- 欧洲国家表现出改善早期放电效率的特殊机会.
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