Daly Caroline Ann, Stepinska Janina, Deptuch Tomasz, Ruzyllo Witold, Fox Kevin, Gitt Anselm, Tendera Michal, Fox Kim
Royal Brompton Hospital, Sydney St. London SW3 6NP, UK.
Int J Cardiol. 2008 Apr 25;125(3):311-8. doi: 10.1016/j.ijcard.2007.01.103. Epub 2007 May 17.
Variations in the resources, stability and priorities of health care systems conceivably affect their capacity to implement health care reform and ensure an evidence based approach to health care. Such variation may partially account for differences in cardiovascular mortality rates between former communist states in Central Europe and Western European countries, but specific data on this subject is sparse. The aim of this study was to compare the presentation of stable angina to cardiology services in Poland vs. the United Kingdom, the management of the condition in relation to existing European guidelines and clinical outcome.
Data was collected as part of a prospective observational cohort study of stable angina in Europe. Information was recorded on referral patterns, clinical presentation and the use of pharmacological therapies, investigations, revascularisation and cardiovascular events during 1 year of follow up. A total of 571 patients with stable angina were enrolled in Poland and 319 in the UK. Patients presenting to cardiology services in Poland were less likely to be referred by a primary care physician, younger, and had more adverse clinical risk predictors at presentation. Non-invasive investigation and coronary angiography were performed less frequently in Poland, but waiting times for invasive assessment were shorter. European guidelines with regard to the use of evidence based secondary preventative medical therapy were applied widely by cardiologists in both countries. No differences were observed in rates of cardiovascular events.
The use of evidence based pharmacological therapy was equally high in both countries, but guidelines regarding investigation were less completely adhered to in Poland, where invasive assessment and subsequent management was prompt but only performed in a highly selected proportion of the population with stable angina.
医疗保健系统在资源、稳定性和优先事项方面的差异可能会影响其实施医疗保健改革以及确保采用循证医疗方法的能力。这种差异可能部分解释了中欧前共产主义国家与西欧国家之间心血管死亡率的差异，但关于这一主题的具体数据很少。本研究的目的是比较波兰和英国稳定型心绞痛患者向心脏病科就诊的情况、根据现有欧洲指南对该病的管理以及临床结局。
数据收集是欧洲稳定型心绞痛前瞻性观察队列研究的一部分。记录了转诊模式、临床表现以及随访1年期间药物治疗、检查、血运重建和心血管事件的使用情况。波兰共纳入571例稳定型心绞痛患者，英国纳入319例。在波兰，向心脏病科就诊的患者由初级保健医生转诊的可能性较小，年龄较轻，就诊时具有更多不良临床风险预测因素。波兰进行非侵入性检查和冠状动脉造影的频率较低，但侵入性评估的等待时间较短。两国的心脏病专家广泛应用了关于使用循证二级预防药物治疗的欧洲指南。心血管事件发生率未见差异。
两国基于证据的药物治疗使用率同样很高，但波兰对检查指南的遵守不够完全，在波兰，侵入性评估及后续治疗迅速，但仅在一小部分高度选定的稳定型心绞痛患者中进行。
