在新英格兰医疗保健系统中改善心血管疾病初级预防治疗门
So Mi Jemma Cho1,2,3, Rachel Rivera1, Satoshi Koyama1,2
1Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.
JACC. Advances
|September 18, 2024
概括
重新校准聚合队列方程 (PCE) 改善了医疗保健机构中的动脉样硬化心血管疾病 (ASCVD) 风险预测. 个性化门提高了他类药物的适用性,并优化了跨不同人口统计学群体的预防策略.
科学领域:
- 心血管医学 心血管医学
- 流行病学 流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 众所周知,对动脉样硬化心血管疾病 (ASCVD) 风险估计的聚合队列方程 (PCE) 在一般人群中高估了风险.
- 在医疗保健系统中,它在不同的人口群体的表现仍然不太了解.
研究的目的:
- 在当代医疗保健系统中重新校准PCE并重新定义初级预防门.
- 通过各种社会人口统计学因素来评估重新校准的方程的性能.
主要方法:
- 从大众医院布里格姆医院 (2010-2012年和2020-2022年) 的电子健康记录的回顾性分析.
- 包括160,926名年龄在40-79岁之间的患者,没有先前的ASCVD或降脂药物.
- 使用校准,区分,重新分类和净收益对原始和重新校准的PCE进行比较.
主要成果:
- 最初的PCE低估了ASCVD风险 (观察到与预测发生率:0.13与0.05).
- 经过重新校准,发现需要使用他类药物治疗的患者数量增加了40%,特别是最初被归类为低至边界风险的患者.
- 最佳值因性别和种族/种族而异,一般建议在生命早期较低的值.
结论:
- 在特定的医疗保健系统中重新校准PCE可以提高ASCVD风险预测的准确性.
- 从重新校准中获得的个性化治疗门可以提高预防性治疗分配的效率.
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