德国冠心病事件后用药的地区差异。

Regional variation in medication following coronary events in Germany.

作者信息

Müller-Nordhorn Jacqueline, Kulig Michael, Binting Sylvia, Völler Heinz, Krobot Karl J, Willich Stefan N

机构信息

Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, D-10098 Berlin, Germany.

出版信息

Int J Cardiol. 2005 Jun 22;102(1):47-53. doi: 10.1016/j.ijcard.2004.03.074.

DOI:10.1016/j.ijcard.2004.03.074

PMID:15939098

Abstract

BACKGROUND

Mortality rates from ischaemic heart disease have consistently been higher in East compared to West Germany both prior to and since reunification. Coronary care is inversely related to mortality from ischaemic heart disease. The objective of the present study was, therefore, to compare cardiovascular medication in East and West German patients following cardiac rehabilitation.

METHODS

East German (n = 530) and West German (n = 1638) patients were included at admission to one of 18 rehabilitation centres. Inclusion criteria were myocardial infarction, coronary artery bypass grafting and percutaneous transluminal coronary angioplasty. The follow-up period was 12 months.

RESULTS

At admission, East and West German patients differed with regard to sociodemographic variables, risk factors and medical conditions. At 12 months, a higher percentage of West compared to East German patients were prescribed beta-blockers (71% vs. 65%, P = 0.04) and lipid-lowering agents (64% vs. 55%, P = 0.002). Angiotensin converting enzyme (ACE) inhibitors, on the other hand, were prescribed more frequently in the East compared to the West (60% vs. 48%, P < 0.001). In multivariable analyses, region of residence remained a significant predictor for the prescription of lipid-lowering agents (East vs. West: OR 0.61, 95% CI 0.46-0.81) and ACE inhibitors (East vs. West: OR 1.78, 95% CI 1.33-2.39).

CONCLUSION

There is a considerable variation in the prescription of cardiovascular medication in secondary prevention within Germany. Some, but not all, of this variation can be explained by differences in patient characteristics.

摘要

背景

在统一之前及之后，东德缺血性心脏病的死亡率一直高于西德。冠心病护理与缺血性心脏病死亡率呈负相关。因此，本研究的目的是比较东德和西德患者心脏康复后的心血管药物使用情况。

方法

18个康复中心之一收治的东德患者（n = 530）和西德患者（n = 1638）被纳入研究。纳入标准为心肌梗死、冠状动脉搭桥术和经皮冠状动脉腔内血管成形术。随访期为12个月。

结果

入院时，东德和西德患者在社会人口统计学变量、危险因素和医疗状况方面存在差异。在12个月时，与东德患者相比，西德患者中开具β受体阻滞剂（71%对65%，P = 0.04）和降脂药（64%对55%，P = 0.002）的比例更高。另一方面，与西德相比，东德更频繁地开具血管紧张素转换酶（ACE）抑制剂（60%对48%，P < 0.001）。在多变量分析中，居住地区仍然是降脂药（东德对西德：比值比0.61，95%置信区间0.46 - 0.81）和ACE抑制剂（东德对西德：比值比1.78，95%置信区间1.33 - 2.39）处方的显著预测因素。