Putnam Wayne, Burge Frederick I, Lawson Beverley, Cox Jafna L, Sketris Ingrid, Flowerdew Gordon, Zitner David
Department of Family Medicine, Dalhousie University, Halifax, NS, Canada.
BMC Fam Pract. 2004 Apr 1;5:6. doi: 10.1186/1471-2296-5-6.
Ischaemic heart disease and congestive heart failure are common and important conditions in family practice. Effective treatments may be underutilized, particularly in women and the elderly. The objective of the study was to determine the rate of prescribing of evidence-based cardiovascular medications and determine if these differed by patient age or sex.
We conducted a two-year cross-sectional study involving all hospitals in the province of Nova Scotia, Canada. Subjects were all patients admitted with ischaemic heart disease with or without congestive heart failure between 15 October 1997 and 14 October 1999. The main measure was the previous outpatient use of recommended medications. Chi-square analyses followed by multivariate logistic regression analyses were used to examine age-sex differences.
Usage of recommended medications varied from approximately 60% for beta-blockers and angiotensin converting enzyme (ACE) inhibitors to 90% for antihypertensive agents. Patients aged 75 and over were significantly less likely than younger patients to be taking any of the medication classes. Following adjustment for age, there were no significant differences in medication use by sex except among women aged 75 and older who were more likely to be taking beta-blockers than men in the same age group.
The use of evidence-based cardiovascular medications is rising and perhaps approaching reasonable levels for some drug classes. Family physicians should ensure that all eligible patients (prior myocardial infarction, congestive failure) are offered beta-blockers or ACE inhibitors.
缺血性心脏病和充血性心力衰竭在家庭医疗中是常见且重要的病症。有效的治疗方法可能未得到充分利用，尤其是在女性和老年人中。本研究的目的是确定循证心血管药物的处方率，并确定这些处方率是否因患者年龄或性别而异。
我们进行了一项为期两年的横断面研究，涉及加拿大新斯科舍省的所有医院。研究对象为1997年10月15日至1999年10月14日期间因缺血性心脏病伴或不伴有充血性心力衰竭入院的所有患者。主要衡量指标是之前门诊使用推荐药物的情况。采用卡方分析，随后进行多因素逻辑回归分析来检验年龄和性别的差异。
推荐药物的使用率有所不同，β受体阻滞剂和血管紧张素转换酶（ACE）抑制剂约为60%，抗高血压药物为90%。75岁及以上的患者服用任何一类药物的可能性明显低于年轻患者。在对年龄进行调整后，除了75岁及以上的女性比同年龄组男性更有可能服用β受体阻滞剂外，不同性别的药物使用情况没有显著差异。
循证心血管药物的使用正在增加，对于某些药物类别可能已接近合理水平。家庭医生应确保为所有符合条件的患者（既往心肌梗死、充血性心力衰竭）提供β受体阻滞剂或ACE抑制剂。
