Jani Sandeep M, Montoye Cecelia, Mehta Rajendra, Riba Arthur L, DeFranco Anthony C, Parrish Robert, Skorcz Stephen, Baker Patricia L, Faul Jessica, Chen Benrong, Roychoudhury Canopy, Elma Mary Anne C, Mitchell Kristi R, Eagle Kim A
Department of Cardiology, University of Michigan Health System, Ann Arbor, USA.
Arch Intern Med. 2006 Jun 12;166(11):1164-70. doi: 10.1001/archinte.166.11.1164.
Studies have shown that women with acute myocardial infarction (AMI) are less likely to receive evidence-based care compared with men. The American College of Cardiology's AMI Guidelines Applied in Practice (GAP) program has been shown to increase the rates of evidence-based medicine use and reduce mortality in patients with AMI. The objective of this study was to investigate the relative benefits of the GAP program in men and women.
By using a predesign-postdesign, standard orders, and a discharge tool to improve evidence-based indicator rates and long-term mortality in patients with AMI in Michigan, this study compared the success of GAP in men vs women. Logistic regression was used to develop predictive models for death at 30 days and 1 year in men and women.
Use of evidence-based care, including use of beta-blockers and aspirin in men and women at hospital discharge and lipid-lowering agent use in men, was higher in the post-GAP sample (P<.01 for all). Use of the discharge tool promoted by the GAP program was independently protective against death at 1 year in women (adjusted odds ratio, 0.46; 95% confidence interval, 0.27-0.79), and a trend existed for similar results in men (adjusted odds ratio, 0.62; 95% confidence interval, 0.36-1.06). However, the tool was used slightly less often with women (27.9% vs 33.96%; P=.003).
The GAP program increased the use of evidence-based therapies in male and female patients. In addition, the GAP discharge tool may decrease mortality rates at 1 year in patients with AMI; however, the tool was used less often with women. Greater use of the GAP discharge tool in women might narrow the post-MI sex mortality gap.
研究表明，与男性相比，急性心肌梗死（AMI）女性患者接受循证治疗的可能性较小。美国心脏病学会的AMI实践应用指南（GAP）项目已被证明可提高循证医学的使用率，并降低AMI患者的死亡率。本研究的目的是调查GAP项目对男性和女性患者的相对益处。
通过使用预设计-后设计、标准医嘱和出院工具，以提高密歇根州AMI患者的循证指标率和长期死亡率，本研究比较了GAP项目在男性和女性患者中的成效。采用逻辑回归分析建立男性和女性患者30天和1年死亡的预测模型。
在GAP项目实施后，循证治疗的使用率有所提高，包括出院时男性和女性使用β受体阻滞剂和阿司匹林，以及男性使用降脂药物（所有P值均<0.01）。GAP项目推广的出院工具可独立降低女性患者1年的死亡风险（调整后的优势比为0.46；95%置信区间为0.27-0.79），男性患者也有类似结果的趋势（调整后的优势比为0.62；95%置信区间为0.36-1.06）。然而，女性使用该工具的频率略低于男性（27.9%对33.96%；P=0.003）。
GAP项目提高了男性和女性患者循证治疗的使用率。此外，GAP出院工具可能会降低AMI患者1年的死亡率；然而，女性使用该工具的频率较低。增加女性对GAP出院工具的使用可能会缩小心肌梗死后的性别死亡率差距。
