基于证据的药物治疗的坚持与急性心肌梗塞后的长期死亡率之间的关系
Jeppe N Rasmussen1, Alice Chong, David A Alter
1Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada.
JAMA
|January 11, 2007
概括
急性心肌梗塞 (AMI) 幸存者的改善药物坚持与更好的生存率有关,这表明药物效应,而不仅仅是健康的行为,推动了这些好处.
科学领域:
- 心血管医学 心血管医学
- 药理学 药理学是指药理学的学科.
- 公共卫生 公共卫生
背景情况:
- 药物坚持对急性心肌梗塞 (AMI) 后存活率的影响尚未完全理解.
- 潜在的混因素包括"健康坚持者"的行为属性,这使得很难分离药理上的好处.
研究的目的:
- 调查 AMI 后幸存的老年人中药物坚持和死亡率之间的联系.
- 区分依从性驱动的药理效益和对生存结果的行为影响.
主要方法:
- 一项以人口为基础的,观察性,纵向研究包括了安大略省的31,455名老年AMI幸存者 (1999-2003).
- 患者被处方他类药物,β-阻断剂或通道阻断剂 (对照组).
- 坚持被分为高 (>80%),中等 (40-79%) 或低 (<40%) 的天数比例,用多变量生存和倾向模型分析.
主要成果:
- 在他类药物使用者中,低坚持与高坚持相比,低坚持显著增加死亡风险 (调整后危险比率[aHR],1.25;P = .001).
- 对他类药物的中间坚持也显示出死亡率增加的趋势 (aHR,1.12;P = .03).
- 类似的,虽然不那么明显的,与β-阻断剂的坚持死亡率的关联被观察到;对于通道阻断剂没有发现任何关联.
结论:
- 在AMI后与药物坚持相关的生存益处是药物类特定的.
- 这些发现表明,坚持通过药理机制而不是仅仅通过"健康的坚持者"效应来改善结果.
- 该研究强调了坚持基于证据的疗法 (如他类药物和β-阻断剂) 对AMI患者的长期存活的重要性.
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