Ma Rui-Hua, Wang Yong-Jun, Wang Chun-Xue, Zhao Xing-Quan, Wang Yin-Long, Xu Ming-Jie, Wei Ming, Li Yao, Zhang Zhuo, Zhang Wei-Wei, Wang Li, Lin Lang, Li Hong-Tao, Zheng Ting, Wang Xian-Wei, Li Jing-Jing, Lü Ying, Qi Dong
Beijing Tiantan Hospital Affiliate of Capital Medical University, Beijing 100050, China.
Zhonghua Yi Xue Za Zhi. 2008 Oct 14;88(37):2618-22.
Poor compliance with evidence-based-medicine guidelines could significantly influence the effect of stroke prevention strategies. The objectives of this survey are to investigate the current status in Beijing of cerebral infarction/TIA (transient ischemic attack) inpatients' adherence to the evidence-based-medicine secondary prevention and behavior modifications both at the discharge and at 90-day follow up.
The survey included cerebral infarction/TIA patients successively admitted from 1, Oct 2006 to 1, May 2007, used ACEI/ARB, Statin, anti-platelet agents therapy, accepted carotid endarterctomy or angioplasty or stent, and modified behaviors to stop smoking and control weight. Data of patients during hospitalization were obtained from the medical documents in the inpatient department of 7 centers. The detailed information included the medicine therapy, lifestyle modifications, patients' social demographic background (age, sex, education and way of payment), major risk factors for stroke, and ischemic event subtypes (TIA or cerebral infarction). Above information of part of patients were collected through telephone interview at 90-day follow-up if the patients were not able to visit the clinic.
708 cerebral infarction/TIA inpatients who didn't have contraindications were included. Among them, the patents who haven't used anti-platelet agents, nor taken statin, nor accepted ACEI/ARB were about 0.4%, 41.8% and 63.6% respectively. Neither 27% of the patients have accepted the instructions on stop smoking. While about 588 patients suitable to drug therapy were followed up at 90 days, but the percentage of these patients who haven't compliance on anti-platelet agents, statin, ACEI/ARB was 26.9%, 52.6% and 59.4% respectively. Only 66.9% of the smoking patients have received the doctor instructions on smoking cessation.
Stroke recurrence rate in China is higher than that of average figures in western countries. One of the key reasons of high recurrence of stroke in China is the poor adherence to stroke secondary prevention guidelines. Thus, investigate current status of secondary prevention among hospitals in capital of China and promote strategies to enhance the adherence to the guidelines and fill the gap between the clinical practice and evidence-based medicine in China, which is able to lower the stroke recurrence and save lives are urgently needed. Physician should take great care of the patient's compliances on the evidenced-based-medicine secondary prevents and behavior modifications, and take effective measures to improve the compliances.
对循证医学指南的依从性不佳会显著影响卒中预防策略的效果。本次调查旨在研究北京地区脑梗死/短暂性脑缺血发作（TIA）住院患者在出院时及90天随访时对循证医学二级预防及行为改变的依从现状。
该调查纳入了2006年10月1日至2007年5月1日期间连续收治的脑梗死/TIA患者，这些患者使用了ACEI/ARB、他汀类药物、抗血小板药物进行治疗，接受了颈动脉内膜切除术或血管成形术或支架置入术，并进行了行为改变以戒烟和控制体重。住院期间患者的数据来自7个中心住院部的医疗文件。详细信息包括药物治疗、生活方式改变、患者的社会人口统计学背景（年龄、性别、教育程度和支付方式）、卒中的主要危险因素以及缺血事件亚型（TIA或脑梗死）。如果患者无法前来门诊就诊，则在90天随访时通过电话访谈收集部分患者的上述信息。
纳入了708例无禁忌证的脑梗死/TIA住院患者。其中，未使用抗血小板药物、未服用他汀类药物、未接受ACEI/ARB治疗的患者分别约占0.4%、41.8%和63.6%。27%的患者均未接受戒烟指导。90天时对约588例适合药物治疗的患者进行了随访，但这些患者中未依从抗血小板药物、他汀类药物、ACEI/ARB治疗的比例分别为26.9%、52.6%和59.4%。仅有66.9%的吸烟患者接受了医生的戒烟指导。
中国的卒中复发率高于西方国家的平均水平。中国卒中复发率高的关键原因之一是对卒中二级预防指南的依从性差。因此，迫切需要调查中国首都地区医院二级预防的现状，推广提高指南依从性的策略，填补中国临床实践与循证医学之间的差距，以降低卒中复发率并挽救生命。医生应高度关注患者对循证医学二级预防及行为改变的依从性，并采取有效措施提高依从性。
