Daugherty Stacie L, Ho P Michael, Spertus John A, Jones Philip G, Bach Richard G, Krumholz Harlan M, Peterson Eric D, Rumsfeld John S, Masoudi Frederick A
Department of Medicine,Division of Cardiology, University of Colorado Denver Health Sciences Center, Denver, CO, USA.
Arch Intern Med. 2008 Mar 10;168(5):485-91; discussion 492. doi: 10.1001/archinte.168.5.485.
Early outpatient follow-up after acute myocardial infarction (AMI) is recommended in guidelines, but its relationship with the use of evidence-based therapies is unknown.
We evaluated 1516 patients hospitalized with AMI from the multicenter Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery registry. Early follow-up was defined as patient- reported visits with a primary care physician or cardiologist within 1 month after discharge. The primary outcomes were use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and statins in eligible patients at 6 months. Multivariable analyses assessed the association between early follow-up and medication use at 6 months, adjusting for patient and clinical characteristics. Secondary analyses compared medication use at 6 months for patients receiving collaborative follow-up from a single provider vs those receiving follow-up from both provider types.
Among the cohort, 34% reported no outpatient follow-up during the month following discharge. Rates of medication prescription among appropriate candidates were similar at hospital discharge for both follow-up groups. Compared with those not receiving early follow-up, those receiving early follow-up were more likely to be prescribed beta-blockers (80.1% vs 71.3%; P = .001), aspirin (82.9% vs 77.1%; P = .01), or statins (75.9% vs 68.6%; P = .005) at 6 months. In multivariable analyses, a persistent relationship remained between early follow-up and beta-blocker use (risk ratio, 1.08; 95% confidence interval, 1.02-1.15). In secondary analyses, statin use was higher in patients receiving collaborative follow-up (risk ratio, 1.11; 95% confidence interval, 1.01-1.22).
Early outpatient follow-up and collaborative follow-up after AMI is associated with higher rates of evidence-based medication use. Although further studies should assess whether this relationship is causal, these results support current guideline recommendations for follow-up after AMI.
急性心肌梗死（AMI）后早期门诊随访在指南中被推荐，但它与循证治疗的使用之间的关系尚不清楚。
我们评估了多中心心肌梗死预后前瞻性注册研究（心肌梗死：事件与恢复注册研究）中1516例因AMI住院的患者。早期随访定义为患者出院后1个月内与初级保健医生或心脏病专家的就诊报告。主要结局是6个月时符合条件的患者使用阿司匹林、β受体阻滞剂、血管紧张素转换酶抑制剂和他汀类药物的情况。多变量分析评估了早期随访与6个月时药物使用之间的关联，并对患者和临床特征进行了调整。二次分析比较了由单一提供者进行协作随访的患者与由两种提供者类型进行随访的患者在6个月时的药物使用情况。
在该队列中，34%的患者报告出院后1个月内无门诊随访。两个随访组中合适候选者的药物处方率在出院时相似。与未接受早期随访的患者相比，接受早期随访的患者在6个月时更有可能被处方β受体阻滞剂（80.1%对71.3%；P = 0.001）、阿司匹林（82.9%对77.1%；P = 0.01）或他汀类药物（75.9%对68.6%；P = 0.005）。在多变量分析中，早期随访与β受体阻滞剂使用之间仍存在持续关系（风险比，1.08；95%置信区间，1.02 - 1.15）。在二次分析中，接受协作随访的患者他汀类药物使用率更高（风险比，1.11；95%置信区间，1.01 - 1.22）。
AMI后早期门诊随访和协作随访与更高的循证药物使用率相关。尽管进一步的研究应评估这种关系是否具有因果性，但这些结果支持当前关于AMI后随访的指南建议。
