Fonarow G C, Gawlinski A, Moughrabi S, Tillisch J H
Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, Department of Medicine, Los Angeles, California, USA.
Am J Cardiol. 2001 Apr 1;87(7):819-22. doi: 10.1016/s0002-9149(00)01519-8.
Despite scientific evidence that secondary prevention medical therapies reduce mortality in patients with established coronary artery disease, these therapies continue to be underutilized in patients receiving conventional care. To address this issue, a Cardiac Hospital Atherosclerosis Management Program (CHAMP) focused on initiation of aspirin, cholesterol-lowering medication (hydroxymethylglutaryl coenzyme A [HMG CoA] reductase inhibitor titrated to achieve low-density lipoprotein [LDL] cholesterol < or =100 mg/dl), beta blocker, and angiotensin-converting enzyme (ACE) inhibitor therapy in conjunction with diet and exercise counseling before hospital discharge in patients with established coronary artery disease. Treatment rates and clinical outcome were compared in patients discharged after myocardial infarction in the 2-year period before (1992 to 1993) and the 2-year period after (1994 to 1995) CHAMP was implemented. In the pre- and post-CHAMP patient groups, aspirin use at discharge improved from 68% to 92% (p <0.01), beta blocker use improved from 12% to 62% (p <0.01), ACE inhibitor use increased from 6% to 58% (p <0.01), and statin use increased from 6% to 86% (p <0.01). This increased use of treatment persisted during subsequent follow-up. There was also a significant increase in patients achieving a LDL cholesterol < or =100 mg/dl (6% vs 58%, p <0.001) and a reduction in recurrent myocardial infarction and 1-year mortality. Compared with conventional guidelines and care, CHAMP was associated with a significant increase in use of medications that have been previously demonstrated to reduce mortality; more patients achieved an LDL cholesterol < or =100 mg/dl, and there were improved clinical outcomes in patients after hospitalization for acute myocardial infarction.
尽管有科学证据表明二级预防医学疗法可降低已确诊冠心病患者的死亡率，但在接受常规治疗的患者中，这些疗法的使用仍未得到充分利用。为解决这一问题，一家心脏病医院开展了动脉粥样硬化管理项目（CHAMP），该项目专注于在已确诊冠心病患者出院前，启动阿司匹林、降胆固醇药物（将羟甲基戊二酰辅酶A [HMG CoA] 还原酶抑制剂滴定至低密度脂蛋白 [LDL] 胆固醇≤100 mg/dl）、β受体阻滞剂和血管紧张素转换酶（ACE）抑制剂治疗，并结合饮食和运动咨询。比较了在CHAMP实施前（1992年至1993年）和实施后（1994年至1995年）这两个2年期间心肌梗死后出院患者的治疗率和临床结局。在CHAMP实施前后的患者组中，出院时阿司匹林的使用率从68%提高到92%（p<0.01），β受体阻滞剂的使用率从12%提高到62%（p<0.01），ACE抑制剂的使用率从6%增加到58%（p<0.01），他汀类药物的使用率从6%增加到86%（p<0.01）。在随后的随访期间，这种治疗的增加使用持续存在。实现LDL胆固醇≤100 mg/dl的患者也显著增加（6%对58%，p<0.001），复发性心肌梗死和1年死亡率降低。与传统指南和治疗相比，CHAMP与先前已证明可降低死亡率的药物使用显著增加相关；更多患者实现了LDL胆固醇≤100 mg/dl，急性心肌梗死后住院患者的临床结局得到改善。
