Salomaa Veikko, Pääkkönen Rauni, Hämäläinen Helena, Niemi Marja, Klaukka Timo
KTL-National Public Health Institute, Helsinki, Finland.
Eur J Cardiovasc Prev Rehabil. 2007 Jun;14(3):386-91. doi: 10.1097/01.hjr.0000244573.10229.6e.
It is not well-known to what extent evidence-based medications, such as beta-blockers, hypolipidemic medications, and angiotensin-converting enzyme inhibitors, are prescribed after an attack of acute coronary syndrome in the general healthcare setting and what is the compliance of patients with these prescriptions.
We conducted a countrywide record linkage study.
We used record linkage of the National Hospital Discharge Register, Causes of Death Register, and Social Insurance Institution's drug reimbursement records to identify drug purchases of patients aged 35-74 years hospitalized for the first nonfatal acute coronary syndrome in Finland during 1995-2003 (n=53 353).
In 2003 about 28 and 15% of the patients did not receive hypolipidemic medications or beta-blockers, respectively, after their acute coronary syndrome and a further 6 and 10% discontinued the use about 3 months later. Patients aged 65-74 years were less likely to receive hypolipidemic medications [odds ratio (OR) 0.55; 95% confidence interval (CI), 0.53-0.58] and beta-blockers (OR 0.77; 95% CI, 0.74-0.81) than younger patients. Diabetic patients received less hypolipidemic medications (OR 0.82; 95% CI, 0.78-0.86) and were more likely to discontinue the medication (OR 1.15; 95% CI, 1.05-1.26) than nondiabetic patients. In proportional hazards regression analyses the regular use of hypolipidemic medication or beta-blockers was associated with lower risk of cardiovascular death: adjusted hazard ratios 0.47 (95% CI, 0.41-0.53) and 0.54 (95% CI, 0.49-0.60), respectively.
Our study showed that the evidence-based use of medications after acute coronary syndrome was suboptimal in Finland, particularly in elderly and diabetic patients. Consistent use of these medications, however, was associated with a better prognosis.
在普通医疗环境中，急性冠状动脉综合征发作后，诸如β受体阻滞剂、降血脂药物和血管紧张素转换酶抑制剂等循证药物的处方开具情况以及患者对这些处方的依从性究竟如何，目前尚不为人熟知。
我们开展了一项全国范围的记录链接研究。
我们利用国家医院出院登记册、死亡原因登记册以及社会保险机构的药品报销记录进行记录链接，以确定1995年至2003年期间在芬兰因首次非致命性急性冠状动脉综合征住院的35至74岁患者的药品购买情况（n = 53353）。
2003年，分别约有28%和15%的患者在急性冠状动脉综合征发作后未接受降血脂药物或β受体阻滞剂治疗，另有6%和10%的患者在大约3个月后停用了这些药物。65至74岁的患者比年轻患者更不太可能接受降血脂药物治疗[比值比（OR）0.55；95%置信区间（CI），0.53 - 0.58]和β受体阻滞剂治疗（OR 0.77；95% CI，0.74 - 0.81）。糖尿病患者比非糖尿病患者接受的降血脂药物更少（OR 0.82；95% CI，0.78 - 0.86），并且更有可能停药（OR 1.15；95% CI，1.05 - 1.26）。在比例风险回归分析中，规律使用降血脂药物或β受体阻滞剂与较低的心血管死亡风险相关：调整后的风险比分别为0.47（95% CI，0.41 - 0.53）和0.54（95% CI，0.49 - 0.60）。
我们的研究表明，在芬兰，急性冠状动脉综合征发作后循证药物的使用情况并不理想，尤其是在老年患者和糖尿病患者中。然而，持续使用这些药物与更好的预后相关。
