Reikvam Asmund, Kvan Elena, Aursnes Ivar
Department of Pharmacotherapeutics, Faculty of Medicine, University of Oslo, N-0316 Oslo, Norway.
Cardiovasc Drugs Ther. 2002 Sep;16(5):451-6. doi: 10.1023/a:1022194604260.
To investigate the prescription pattern for cardiovascular drugs among patients discharged after an acute myocardial infarction (AMI) in hospitals that had participated in a corresponding study seven years earlier, and examine what the indications were for use of the different drugs.
From 16 hospitals we drew a sample of patients who were discharged with a diagnosis of AMI during a three months period in 1999/2000. Physicians in each hospital obtained from the medical records the observed rate of use of cardiovascular drugs at discharge. The drug use was compared with findings from a corresponding sample drawn in 1993. The main indication for use of the different cardiovascular drugs was recorded for the 1999/2000 sample.
399 patients discharged alive were included in the first study and 767 in the second. The use of beta-blockers, ACE inhibitors and statins rose substantially during the period. For patients aged </=70 drug use in respectively 1993 and 1999/2000 was as follows: beta-blockers 73% vs 89%, ACE inhibitors 14% vs 29%, statins not recorded vs 82%; corresponding figures for patients aged >70 were: beta-blockers 45% vs 74%, ACE inhibitors 19% vs 38%, statins not recorded vs 35%. Aspirin/anticoagulant use was largely unchanged; 93% and 70% of patients aged </=70 and >70 respectively used these drugs at the second survey. The use of regular nitrates and calcium antagonists had decreased. Nearly half of the >70 group and one-fifth of persons </=70 used 5-9 cardiovascular drugs.
At the end of the 1990s a substantial shift in drug therapy after AMI occurred, with a markedly increased use of drugs proven to be effective in clinical trials and less use of other cardiovascular drugs. The most frequently reported main indication for use of drugs was secondary prevention. The principles of evidence-based drug therapy became increasingly adopted among clinicians during the 1990s.
调查7年前参与过一项相应研究的医院中，急性心肌梗死（AMI）后出院患者的心血管药物处方模式，并研究不同药物的使用指征。
从16家医院抽取1999/2000年3个月期间诊断为AMI并出院的患者样本。每家医院的医生从病历中获取出院时心血管药物的观察使用率。将药物使用情况与1993年抽取的相应样本的结果进行比较。记录1999/2000年样本中不同心血管药物的主要使用指征。
第一项研究纳入了399例存活出院患者，第二项研究纳入了767例。在此期间，β受体阻滞剂、血管紧张素转换酶抑制剂（ACE抑制剂）和他汀类药物的使用大幅增加。对于年龄≤70岁的患者，1993年和1999/2000年的药物使用情况如下：β受体阻滞剂分别为73%和89%，ACE抑制剂分别为14%和29%，他汀类药物1993年未记录而2000年为82%；年龄>70岁患者的相应数据为：β受体阻滞剂分别为45%和74%，ACE抑制剂分别为19%和38%，他汀类药物1993年未记录而2000年为35%。阿司匹林/抗凝剂的使用基本未变；在第二次调查中，年龄≤70岁和>70岁的患者分别有93%和70%使用了这些药物。长效硝酸盐类药物和钙拮抗剂的使用有所减少。年龄>70岁组近一半的患者和年龄≤70岁组五分之一的患者使用了5 - 9种心血管药物。
20世纪90年代末，AMI后的药物治疗发生了重大转变，经临床试验证明有效的药物使用显著增加，而其他心血管药物的使用减少。最常报告的药物使用主要指征是二级预防。20世纪90年代，临床医生越来越多地采用循证药物治疗原则。
