[克拉科夫缺血性心脏病二级预防项目。1997 - 1998年及1999 - 2000年出院后缺血性心脏病的二级预防]

[Cracovian program for secondary prevention of ischemic heart disease. Secondary prevention of ischemic heart disease after discharge in 1997-98 and 1999-2000].

作者信息

Jankowski Piotr, Kawecka-Jaszcz Kalina, Pajak Andrzej, Bilo Grzegorz, Dubiel Jacek S, Maciejewicz Janusz, Piotrowski Wiesław, Smielak-Korombel Wanda, Tracz Wiesława

机构信息

I Klinika Kardiologii Instytutu Kardiologii Collegium Medicum Uniwersytetu Jagiellońskiegio w Krakowie, 31-501 Kraków, ul. Kopernika 17.

出版信息

Przegl Lek. 2003;60(3):142-6.

PMID:14575014

Abstract

INTRODUCTION

Although most actions undertaken within the scope of the secondary prevention of ischaemic heart disease should be initiated during hospitalization, obtaining maximal effects (quantified by cardiovascular risk reduction) depends largely on continuation and appropriate adjustment of these measures in the post-discharge period. The aim of this paper is to assess the implementation of guidelines on secondary prevention of ischaemic heart disease in the period after discharge from the hospital in the years 1999/2000 as compared with 1997/98.

MATERIAL AND METHODS

In the first phase 515 subjects hospitalized in cardiac departments of university and general hospitals in Cracow were included. Out of them, 427 patients attended the control visit 6-18 months after index hospitalization. Based on a standardized questionnaire a structured medical history was obtained including the presence of risk factors and medication. At the same time body height and mass and blood pressure were measured and blood samples were obtained for lipid profile and fasting glucose level.

RESULTS

Elevated cholesterol levels (> or = 5.2 mmol/l) were observed in 65.8% of patients in 1998/99 and 66.3% in 1999/2000, high blood pressure (> or = 140/90 mmHg) in 46.2% and 50.4%, obesity (BMI > or = 30 kg/m2) in 24.6% and 27.2%, fasting hyperglycemia (> or = 6.0 mmol/l) in 17.7% and 27.4% (p < 0.05) and smoking in 16.3% and 15.9%, respectively. An increase was observed in the rate of antiplatelet (76.1% in 1998/99 vs 86.7% in 1999/2000, p < 0.001) and lipid lowering drug use (34.0% vs 41.9%, p < 0.05). The rate of beta-blockers and ACE inhibitors use did not change significantly.

CONCLUSIONS

In the years 1999/2000 the control of main risk factors of ischaemic heart disease did not improve when compared with 1997/98. There was only an increase in the percentage of patients on antiplatelet and lipid lowering drugs. These results indicate that the dissemination of the guidelines for secondary prevention of ischaemic heart disease among physicians and patients remains one of the top priorities of cardiology in Poland.

摘要

引言

尽管缺血性心脏病二级预防范围内的大多数措施应在住院期间启动，但要获得最大效果（通过降低心血管风险来量化）在很大程度上取决于出院后这些措施的持续实施和适当调整。本文旨在评估1999/2000年与1997/98年相比，医院出院后缺血性心脏病二级预防指南的实施情况。

材料与方法

第一阶段纳入了515名在克拉科夫大学医院和综合医院心脏科住院的患者。其中，427名患者在首次住院后6 - 18个月参加了对照访视。通过标准化问卷获取结构化病史，包括危险因素的存在情况和用药情况。同时测量身高、体重和血压，并采集血样检测血脂谱和空腹血糖水平。

结果

1998/99年65.8%的患者胆固醇水平升高（≥5.2 mmol/l），1999/2000年为66.3%；高血压（≥140/90 mmHg）患者比例分别为46.2%和50.4%；肥胖（BMI≥30 kg/m²）患者比例分别为24.6%和27.2%；空腹血糖升高（≥6.0 mmol/l）患者比例分别为17.7%和27.4%（p<0.05）；吸烟患者比例分别为16.3%和15.9%。抗血小板药物使用率有所增加（1998/99年为76.1%，1999/2000年为86.7%，p<0.001），降脂药物使用率也增加（34.0%对41.9%，p<0.05）。β受体阻滞剂和ACE抑制剂的使用率没有显著变化。