医院对二次预防药物坚持率的变化以及对质量的影响
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
概括
医院对心肌梗塞 (MI) 后药物的坚持有所不同,影响患者的结果. 较高的住院执法率与更好的长期心血管事件预防有关.
科学领域:
- 心脏病学
- 医疗服务研究
- 药理学
背景情况:
- 药物坚持是急性心肌梗塞 (MI) 后改善长期结果的关键.
- 在治疗心脏病患者的美国医院中,药物坚持存在显著差异.
- 患者的结局被假定与心脏病发作后的医院水平药物坚持率相关.
研究的目的:
- 调查急性心肌梗塞 (MI) 后美国医院药物坚持的差异.
- 确定心脏病发作患者在医院服药程度与长期心血管结果之间的关联.
主要方法:
- 使用了来自347家医院的19704名心脏病发作后出院的医疗保险数据 (ACTION Registry- GWTG).
- 使用医疗保险 (Medicare) D部分数据,定义药物坚持为医疗保险出院后90天内覆盖日数的>80%.
- 使用Cox比例风险建模来比较不同水平的医院两年的重大心血管不良事件 (MACE).
主要成果:
- 整体90天的坚持率:β- 阻断剂 (68%),他类药物 (63%),ACE抑制剂/ ARBs (64%),皮类药物 (72%).
- 在所有药物类别中观察到显著的医院水平依从率.
- 与最低四分位数相比,依从度最高的医院显示较低的调整后2年MACE风险 (aHR,0. 88) 和较低的调整后死亡或再入院率 (aHR,0. 90).
结论:
- 退院后的二次预防药物使用在美国各医院有很大差异.
- 医院药物坚持与2年的心血管不良结果相反相关.
- 在住院和门诊之间改善的护理协调可以提高药物坚持和心脏病发作后的患者结果.
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