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对于急性心肌梗塞的符合条件的老年患者进行血栓抑制疗法
H M Krumholz1, J E Murillo, J Chen
1Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT 06520-8017, USA.
JAMA
|June 4, 1997
概括
许多老年患者在心脏病发作后有资格接受血栓抑制剂治疗,但没有接受治疗. 医生的判断,而不是省略,影响决策,有时与证据相反,表明改善护理的机会.
科学领域:
- 心脏病学 心脏病学
- 老年医学 老年医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 血栓溶解药物治疗是急性心肌梗塞 (AMI) 的关键治疗方法.
- 老年患者 (≥65岁) 是患有AMI住院的重要人口.
- 了解影响这种人口群体使用血栓消毒疗法的因素对于优化护理至关重要.
研究的目的:
- 为了确定与使用血栓抑制剂治疗在患有AMI住院的老年患者的相关性.
- 检查符合条件的老年人中拒绝使用血栓溶解药物治疗的原因.
主要方法:
- 使用医疗图表和行政数据进行回顾性队列研究.
- 从1992年5月到1993年5月,包括3093名65岁以上的Medicare受益者,他们患有AMI.
- 对753名符合条件的患者进行分析,这些患者未被转诊至立即再血管.
主要成果:
- 56%的符合条件的老年患者没有接受血栓抑制剂治疗.
- 没有治疗的预测因素包括晚年,没有胸痛,延迟呈现 (>6小时),左捆分支阻塞和精神状态改变.
- 医生文档将延迟和年龄列为不接受治疗的主要原因.
结论:
- 在符合条件的老年AMI患者中,很大一部分没有接受血栓抑制剂治疗.
- 治疗决策似乎是基于临床判断,有时与基于证据的指导方针有所不同,特别是在老年方面.
- 这些发现突出了改善准则遵守和急性心肌梗塞管理患者护理的潜在领域.
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