van der Elst Menno E, Bouvy Marcel L, de Blaey Cornelis J, de Boer Anthonius
Department of Pharmacotherapy and Pharmacoepidemiology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Sorbonnelaan 16, 3584 CA Utrecht, The Netherlands.
Clin Ther. 2005 Nov;27(11):1806-14. doi: 10.1016/j.clinthera.2005.11.003.
Myocardial infarction (MI) is a common cause of death in developed countries. Long-term preventive pharmacotherapy has been shown to decrease mortality and morbidity after MI. Based on a literature search, studies of these therapies to date have estimated the use of monotherapy, whereas many patients are prescribed combination therapy. Thus, assessment of long-term combination drug use after MI is timely.
The aim of this study was to assess the use of oral antithrombotics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, hydroxymethyl-glutaryl coenzyme A reductase inhibitors ("statins"), and their combinations after MI at discharge and during 12-year follow-up.
This community-based, retrospective data analysis was conducted at Utrecht University, Utrecht, The Netherlands. Data from patients aged > or =18 years at hospital admission who experienced nonfatal acute MI between 1991 and 2000 and had a duration of follow-up > or =30 days were included in the analysis. Data were retrieved from the Pharmo Record Linkage System database, which links pharmacies' dispensation records to hospitals' discharge records on an individual patient level, allowing the investigator to observe individual patients' medication use over time. Primary outcome measures were the use of preventive medicines (oral antithrombotics, beta-blockers, ACE inhibitors, and statins) at discharge, overall use, and persistence during 12-year follow-up.
Of 330,000 patients in the database, 4007 were included in the analysis (2828 men, 1179 women; mean [SD] age, 63.5 [12.5] years). Use at discharge and overall use of oral antithrombotics and statins increased significantly between 1991 and 2000, whereas use of beta-blockers and ACE inhibitors increased mainly in patients discharged in the latter years of the follow-up period. Therapy with any combination of drugs increased strikingly from 1991 to 2000, from 47% to 90%. At 1 year after discharge, 32% of patients had discontinued their first-prescribed combination treatments. At 5 years after discharge, this rate increased to 57%, suggesting a low rate of persistence
Based on the results of this retrospective data analysis, the use of MI-preventive drug treatment at and after discharge increased significantly in this population in The Netherlands during the 1990s. Combination therapy increased strikingly. However, persistence with combination therapy was low.
心肌梗死（MI）是发达国家常见的死亡原因。长期预防性药物治疗已被证明可降低心肌梗死后的死亡率和发病率。基于文献检索，迄今为止对这些疗法的研究估计了单一疗法的使用情况，而许多患者使用的是联合疗法。因此，及时评估心肌梗死后长期联合用药情况很有必要。
本研究旨在评估心肌梗死后出院时以及12年随访期间口服抗血栓药物、β受体阻滞剂、血管紧张素转换酶（ACE）抑制剂、羟甲基戊二酰辅酶A还原酶抑制剂（“他汀类药物”）及其联合用药的使用情况。
这项基于社区的回顾性数据分析在荷兰乌得勒支的乌得勒支大学进行。纳入分析的患者为1991年至2000年间入院时年龄≥18岁、发生非致命性急性心肌梗死且随访时间≥30天的患者。数据从Pharmo Record Linkage System数据库中获取，该数据库在个体患者层面将药房的配药记录与医院的出院记录相链接，使研究者能够观察个体患者随时间的用药情况。主要结局指标为出院时预防性药物（口服抗血栓药物、β受体阻滞剂、ACE抑制剂和他汀类药物）的使用情况、总体使用情况以及12年随访期间的持续用药情况。
数据库中的330,000名患者中，4007名被纳入分析（男性2828名，女性1179名；平均[标准差]年龄63.5[12.5]岁）。1991年至2000年间，出院时及口服抗血栓药物和他汀类药物的总体使用情况显著增加，而β受体阻滞剂和ACE抑制剂的使用主要在随访后期出院的患者中增加。从1991年到2000年，任何药物联合治疗的使用显著增加，从47%增至90%。出院1年后，32%的患者停止了首次开具的联合治疗。出院5年后，这一比例增至57%，表明持续用药率较低。
基于这项回顾性数据分析的结果，20世纪90年代荷兰该人群中心肌梗死后出院时及出院后的预防性药物治疗使用显著增加。联合治疗显著增加。然而，联合治疗的持续用药率较低。
