Fiellin David A, O'Connor Patrick G, Wang Yongfei, Radford Martha J, Krumholz Harlan M
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8088, USA.
Alcohol Clin Exp Res. 2006 Jan;30(1):70-5. doi: 10.1111/j.1530-0277.2006.00001.x.
Elderly adults with alcohol-related diagnoses represent a vulnerable population that may receive lower quality of treatment during hospitalization for acute myocardial infarction. We sought to determine whether elderly patients with alcohol-related diagnoses are less likely to receive standard indicators of quality care for acute myocardial infarction.
We conducted a retrospective cohort analysis using administrative and medical record data from the Cooperative Cardiovascular Project. Subjects were Medicare beneficiaries with a confirmed principal discharge diagnosis of acute myocardial infarction from all acute care hospitals in the United States over an 8-month period. Our primary outcome was the receipt of 7 guideline-recommended care measures among all eligible patients and patients who were ideal candidates for a given measure.
In all, 1,284 (1%) of the 155,026 eligible patients met criteria for an alcohol-related diagnosis. Among the alcohol-related diagnoses, 1,077/1,284 (84%) were for the diagnoses of alcohol dependence or alcohol abuse. Patients with alcohol-related diagnoses were less likely than those without alcohol-related diagnoses to receive beta-blockers at the time of discharge (55% vs. 60%, p = 0.02). We found no other significant differences in performance of the quality indicators after stratifying by indication and adjustment for baseline characteristics.
Alcohol-related diagnoses are not a barrier to receiving most quality of care measures in elderly patients hospitalized for acute myocardial infarction.
患有酒精相关诊断的老年成年人是一个弱势群体，在急性心肌梗死住院期间可能接受较低质量的治疗。我们试图确定患有酒精相关诊断的老年患者接受急性心肌梗死标准质量护理指标的可能性是否较低。
我们使用合作心血管项目的行政和医疗记录数据进行了一项回顾性队列分析。研究对象是美国所有急性护理医院在8个月期间确诊为急性心肌梗死的医疗保险受益人。我们的主要结局是所有符合条件的患者以及某项措施的理想候选患者中接受7项指南推荐护理措施的情况。
在155,026名符合条件的患者中，共有1,284名（1%）符合酒精相关诊断标准。在酒精相关诊断中，1,077/1,284（84%）为酒精依赖或酒精滥用诊断。患有酒精相关诊断的患者出院时接受β受体阻滞剂的可能性低于无酒精相关诊断的患者（55%对60%，p = 0.02）。在按指征分层并对基线特征进行调整后，我们发现质量指标的表现没有其他显著差异。
对于因急性心肌梗死住院的老年患者，酒精相关诊断并非接受大多数质量护理措施的障碍。
