Vale Margarite J, Jelinek Michael V, Best James D
Department of Cardiology, St Vincent's Hospital, Melbourne, VIC.
Med J Aust. 2002 Mar 4;176(5):211-5. doi: 10.5694/j.1326-5377.2002.tb04375.x.
To determine the proportion of patients with established coronary heart disease (CHD) in two Australian studies (VIC-I in 1996-1998, and VIC-II in 1999-2000) who achieved their risk-factor targets as recommended by the National Heart Foundation of Australia, and to compare this proportion with those in studies from the United Kingdom (ASPIRE), Europe (EUROASPIRE I and II) and the United States (L-TAP).
Prospective cohort study with VIC-I set in a single Melbourne university teaching hospital and VIC-II set in six university teaching hospitals in Melbourne, Victoria.
460 patients (112 in VIC-I, 348 in VIC-II) who completed follow-up in the control groups of two randomised controlled trials of a coaching intervention in patients with established CHD.
The treatment gap (100%, minus the percentage of patients achieving the target level for a particular modifiable risk factor) at six months after hospitalisation.
The treatment gap declined from 96.4% (95% CI, 91%-99%) to 74.1% (95% CI, 69%-79%) for total cholesterol concentration (TC) < 4.0 mmol/L (P = 0.0001) and from 90.2% (95% CI, 83%-95%) to 54.0% (95% CI, 49%-59%) for TC < 4.5 mmol/L (P = 0.0001). This reduction in the treatment gap between VIC-I and VIC-II appears to be entirely explained by an increase in the number of patients prescribed lipid-lowering drugs. The treatment gaps in the UK and two European studies were substantially greater. The treatment gap for blood pressure (systolic > or = 140 mmHg and/or diastolic > or = 90 mmHg) in VIC-II was 39.5%, again less than corresponding European data. There were 8.1% of patients who had unrecognised diabetes in VIC-II (fasting glucose level > or = 7 mmol/L), making a total of 25.6% of VIC-II patients with diabetes, self-reported or unrecognised. The proportion of patients in VIC-II who were obese (body mass index > or = 30 kg/m2) was similar to the overseas studies, while fewer patients in VIC-II smoked compared with those in the UK and European studies.
A substantial treatment gap exists in Victorian patients with established CHD. The treatment gap compares well with international surveys and, at least in the lipid area, is diminishing.
确定在两项澳大利亚研究（1996 - 1998年的VIC - I和1999 - 2000年的VIC - II）中，已确诊冠心病（CHD）的患者达到澳大利亚国家心脏基金会推荐的危险因素目标的比例，并将该比例与英国（ASPIRE）、欧洲（EUROASPIRE I和II）及美国（L - TAP）的研究结果进行比较。
前瞻性队列研究，VIC - I在墨尔本一家大学教学医院开展，VIC - II在维多利亚州墨尔本的六家大学教学医院开展。
460例患者（VIC - I中有112例，VIC - II中有348例），这些患者完成了针对已确诊CHD患者的一项辅导干预的两项随机对照试验对照组的随访。
住院后6个月时的治疗差距（100%减去达到特定可改变危险因素目标水平的患者百分比）。
对于总胆固醇浓度（TC）<4.0 mmol/L，治疗差距从96.4%（95%CI，91% - 99%）降至74.1%（95%CI，69% - 79%）（P = 0.0001）；对于TC<4.5 mmol/L，治疗差距从90.2%（95%CI，83% - 95%）降至54.0%（95%CI，49% - 59%）（P = 0.0001）。VIC - I和VIC - II之间治疗差距的缩小似乎完全是由于开具降脂药物的患者数量增加所致。英国和两项欧洲研究中的治疗差距要大得多。VIC - II中血压（收缩压≥140 mmHg和/或舒张压≥90 mmHg）的治疗差距为39.5%，同样低于相应的欧洲数据。VIC - II中有8.1%的患者患有未被识别的糖尿病（空腹血糖水平≥7 mmol/L），使得VIC - II中自我报告或未被识别的糖尿病患者总数达到25.6%。VIC - II中肥胖（体重指数≥30 kg/m²）患者的比例与海外研究相似，而VIC - II中吸烟的患者比英国和欧洲研究中的患者少。
维多利亚州已确诊CHD的患者存在较大的治疗差距。该治疗差距与国际调查结果相比情况良好，并且至少在血脂领域正在缩小。
