Graham J J, Timmis A, Cooper J, Ramdany S, Deaner A, Ranjadayalan K, Knight C
Department of Cardiology, Barts and the London NHS Trust, London Chest Hospital, London, UK.
Heart. 2006 Mar;92(3):301-6. doi: 10.1136/hrt.2004.051466. Epub 2005 May 20.
To evaluate the impact the National Service Framework (NSF) for coronary heart disease has had on emergency treatment and outcomes in patients presenting with acute coronary syndromes.
Retrospective cohort study.
Coronary care units of two district general hospitals.
Data from 3371 patients were recorded, 1993 patients in the 27 months before the introduction of the NSF and 1378 patients in the 24 months afterwards. After the introduction of the NSF in-hospital mortality was significantly reduced (95 patients (4.8%) v 43 (3.2%), p = 0.02). This was associated with a reduction in the development of Q wave myocardial infarction (40.6% v 33.3%, p < 0.0001) and in the incidence of left ventricular failure (15.9% v 12.3%, p = 0.003). The proportion of patients receiving thrombolysis increased (69.4% v 84.7%, p < 0.0001) with a decrease in the time taken to receive it (proportion thrombolysed within 20 minutes 12.1% v 26.6%, p < 0.0001). The prescription of beta blockers (51.9% v 65.8%, p < 0.0001), angiotensin converting enzyme inhibitors (37% v 66.4%, p < 0.0001), and statins (55.2% v 72.7%, p < 0.0001) improved and the proportion of patients referred for invasive investigation increased (18.3% v 27.0%, p < 0.0001). Trend analysis showed that improvements in mortality and thrombolysis were directly associated with publication of the NSF, whereas the improvements seen in prescription of beta blockers and statins were the continuation of pre-existing trends.
In the two years that followed publication of the NSF the initial treatment and outcome of patients presenting with acute coronary syndromes improved. Some of the improvements can be attributed to the NSF but others are continuations of pre-existing trends.
评估冠心病国家服务框架（NSF）对急性冠状动脉综合征患者的急诊治疗及治疗结果的影响。
回顾性队列研究。
两家地区综合医院的冠心病监护病房。
记录了3371例患者的数据，在NSF实施前的27个月中有1993例患者，之后的24个月中有1378例患者。NSF实施后，院内死亡率显著降低（95例患者（4.8%）对43例（3.2%），p = 0.02）。这与Q波心肌梗死发生率的降低（40.6%对33.3%，p < 0.0001）和左心室衰竭发生率的降低（15.9%对12.3%，p = 0.003）相关。接受溶栓治疗的患者比例增加（69.4%对84.7%，p < 0.0001），且接受溶栓治疗的时间缩短（20分钟内接受溶栓治疗的比例为12.1%对26.6%，p < 0.0001）。β受体阻滞剂（51.9%对65.8%，p < 0.0001）、血管紧张素转换酶抑制剂（37%对66.4%，p < 0.0001）和他汀类药物（55.2%对72.7%，p < 0.0001）的处方情况有所改善，接受侵入性检查的患者比例增加（18.3%对27.0%，p < 0.0001）。趋势分析表明，死亡率和溶栓治疗的改善与NSF的发布直接相关，而β受体阻滞剂和他汀类药物处方的改善是先前趋势的延续。
在NSF发布后的两年里，急性冠状动脉综合征患者的初始治疗及治疗结果有所改善。部分改善可归因于NSF，但其他改善是先前趋势的延续。
