符合心力衰竭指南建议和医院质量措施所需的药物启动负担
Larry A Allen1, Gregg C Fonarow2, Li Liang2
1From Division of Cardiology and the Colorado Cardiovascular Outcomes Research Consortium, University of Colorado School of Medicine, Aurora (L.A.A., F.A.M., J.S.R., P.M.H.); University of California Los Angeles Medical Center, Los Angeles (G.C.F.); Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (L.L., P.L.S., Z.J.E., A.F.H., E.D.P.); Veterans Affairs Medical Center, Denver, CO (J.S.R., P.M.H.); Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA (P.A.H.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Section of Cardiovascular Medicine and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.). larry.allen@ucdenver.edu.
四分之一的心力衰竭患者在出院时需要多种新药来达到质量标准. 有效的过渡护理需要系统来管理心力衰竭 (HF) 患者的新处方和多药.
科学领域:
- 心脏病学
- 药理学
- 医疗服务研究
背景情况:
- 在医院出院之前,心力衰竭 (HF) 准则建议以准则为导向的医疗治疗.
- 一些HF治疗包括在公开报告的性能指标中.
- 对于个体HF患者来说,新药的负担还没有得到充分描述.
研究的目的:
- 针对心力衰竭 (HF) 患者的指导药物治疗的规范.
- 确定有资格在出院时接受新药的HF患者比例.
- 描述指示和实际新处方之间的差距.
主要方法:
- 来自271家医院的Get With The Guidelines-HF注册数据 (2008-2013) 的分析.
- 主要HF药物的处方特征:ACE抑制剂/ARB,β- 阻断剂,阿尔多抗体,氨酸/异酸盐和抗凝剂.
- 根据HF质量指标计算入院和出院药物治疗方案之间的差异.
主要成果:
- 在158,922名HF患者中,显著比例的患者有资格接受新的药物:ACE抑制剂/ ARB (18. 1%),β- 阻断剂 (20. 3%),阿尔多抗剂 (24. 1%),氨酸/ 异酸盐 (8. 6%) 和抗凝剂 (18. 0%).
- 累计,22. 7% 的患者有资格接受一种新药组,9. 4% 接受三种新药组,0. 4% 接受五种新药组.
- 实际新处方 (平均1. 16±1. 00) 低于指定的新药 (平均1. 45±1. 23).
结论:
- 大约25%的住院心力衰竭患者需要开始服用多种药物以达到质量标准.
- 对于HF患者的有效过渡护理需要强大的药物启动和多药房管理系统.
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