Jeantet Marine, Gosselin Sophie, Lefrand Emeline, Hunold Hervé, Vanbockstael Vincent, Bertrand Dominique, Danchin Nicolas
Caisse centrale de la mutualité sociale agricole, Les Mercuriales, Bagnolet, Cedex, France.
Presse Med. 2006 Jul-Aug;35(7-8):1123-30. doi: 10.1016/s0755-4982(06)74768-6.
To describe the treatment of ambulatory patients with coronary artery disease, using information from the French farmers' insurance fund (Mutualité Sociale Agricole, MSA) database.
Analysis of cardiovascular medications bought and reimbursed during the second quarter of 2004 for 16,694 patients affiliated with the MSA who were first diagnosed with coronary artery disease in 1998, 2001 or 2003.
On average, 71% of patients received antiplatelet agents, 56% beta-blockers, 59% statins, and 36% ACE inhibitors. Only 32% received the combination of antiplatelet agents, statins, and beta-blockers, and only 14% all four classes. Practice guidelines were followed more closely in patients diagnosed most recently. Patients receiving all four classes of secondary prevention medication more often has a history of myocardial infarction or were younger. Average doses were consistent with recommendations for beta-blockers, but appeared too low for ACE inhibitors and statins (except for atorvastatin).
Medical management of patients with chronic coronary artery disease in France, while still suboptimal, is improving. Our findings, which are concordant with previous registry data, emphasize the underuse of recognized secondary prevention medications in very elderly patients and the importance of the initial prescription at diagnosis.
利用法国农民保险基金（农业社会互助会，MSA）数据库中的信息，描述冠心病门诊患者的治疗情况。
分析2004年第二季度16694名隶属于MSA且于1998年、2001年或2003年首次被诊断为冠心病的患者所购买和报销的心血管药物。
平均而言，71%的患者接受了抗血小板药物治疗，56%接受了β受体阻滞剂治疗，59%接受了他汀类药物治疗，36%接受了血管紧张素转换酶抑制剂治疗。只有32%的患者同时接受了抗血小板药物、他汀类药物和β受体阻滞剂治疗，只有14%的患者接受了所有四类药物治疗。在最近被诊断的患者中，更严格地遵循了实践指南。接受所有四类二级预防药物治疗的患者更常有心肌梗死病史或年龄较轻。平均剂量与β受体阻滞剂的推荐剂量一致，但对于血管紧张素转换酶抑制剂和他汀类药物（阿托伐他汀除外）似乎过低。
法国慢性冠心病患者的药物治疗虽然仍未达到最佳水平，但正在改善。我们的研究结果与之前的登记数据一致，强调了在高龄患者中公认的二级预防药物使用不足的情况以及诊断时初始处方的重要性。
