在心力衰竭的药物治疗中,风险与治疗不匹配
Douglas S Lee1, Jack V Tu, David N Juurlink
1Institute for Clinical Evaluative Sciences, Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
JAMA
|September 15, 2005
概括
患有高死亡风险的心力衰竭的患者不太可能接受关键药物,如ACE抑制剂和β抑制剂. 这项研究突出了护理方面的差距,因为高风险患者的药物治疗率较低.
科学领域:
- 心脏病学 心脏病学
- 药物治疗 药物治疗
- 医疗保健服务研究 医疗服务研究
背景情况:
- 心力衰竭 (HF) 患者表现出不同的死亡风险.
- 优化药物治疗需要针对高风险个体进行向药物管理.
研究的目的:
- 研究与心力衰竭患者死亡风险相关的药物治疗模式.
- 根据预测的1年死亡风险,识别药物使用的差异.
主要方法:
- 对加拿大安大略省有效心脏治疗 (EFFECT) 队列增强反的分析 (1999-2001).
- 包括1418名住院心力衰竭患者 (LVEF ≤40%,年龄 ≤79岁),预测死亡风险低,平均或高.
- 在出院时和出院后90天内,对ACE抑制剂,ACE抑制剂/ARBs和β-阻断剂的处方率的评估.
主要成果:
- 在出院时,在高风险患者和低风险患者中观察到较低的ACE抑制剂 (60%vs. 81%),ACE抑制剂/ARBs (65%vs. 86%) 和β-抑制剂 (24%vs. 40%) 的处方率.
- 这种趋势在放弃后的90天和1年内持续存在 (趋势为P<.001).
- 与低风险患者相比,高风险患者接受ACE抑制剂/ARBs (aHR 1.61) 和β-抑制剂 (aHR 1.80) 的可能性明显低,即使经过对混因素的调整.
结论:
- 矛盾的是,心力衰竭患者死亡风险最高的人最不可能接受指导方针推的治疗.
- 这种差异表明,对于高风险的HF患者来说,最佳治疗的潜在障碍是高风险的HF患者.
- 进一步研究这种不匹配的原因对于改善患者护理和结果至关重要.
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