保加利亚急性心肌梗死患者的医疗质量：一项横断面研究。
Quality of care of patients with acute myocardial infarction in Bulgaria: a cross-sectional study.
作者信息
Ganova-Iolovska Milka, Kalinov Krassimir, Geraedts Max
机构信息
National Center of Public Health Protection, 15, Ivan Ev, Geshov Blvd, 1341 Sofia, Bulgaria.
出版信息
BMC Health Serv Res. 2009 Jan 26;9:15. doi: 10.1186/1472-6963-9-15.
BACKGROUND
Cardiovascular diseases are the major cause of death in Bulgaria. Because of notable differences in mortality rates between Bulgaria and other European countries, we presume a tangible difference in the management of acute myocardial infarction (AMI) and an underutilization of evidence-based treatments. In order to determine the quality of care of patients with AMI in Bulgaria, we analyzed the appropriateness of current treatments and their relation to patient characteristics.
METHODS
We performed a descriptive cross-sectional study, using retrospectively collected data from medical charts. We included all patients with AMI, residing and admitted to hospitals in the region of Stara Zagora, Bulgaria, between September 1st and December 31st, 2004. Socioeconomic status was surveyed within the framework of a structured patient interview. We used chi-square tests with Fisher's exact probabilities to analyze the relationship between prehospital time delay age, sex, and socio-economic status of the patients and Student's independent samples t-tests to check hypotheses about means.
RESULTS
From 134 patients with AMI (mean age 64.6, SD 13.2, 66% male), 7% presented to a hospital within 59 minutes, and 44% within 4 hours of symptoms onset. The use of Heparin was 98%. In the first 24 hours, ASS was administrated in 82% and beta-Blockers in 73% of the cases. At discharge Aspirin, beta-Blockers, Angiotensin Converting Enzyme Inhibitors or AR-Blockers and Statins were used in 85%, 79%, 66%, and 43% of cases respectively. Intravenous fibrinolysis was applied in 32% of the eligible patients with ST-segment elevation. Percutaneous coronary interventions were applied in four patients within the first month after AMI. Hospital location in relation to a patient's place of residence and manner of transportation to hospital did not influence the time delay between the onset of symptoms to the start of hospital treatment. In the study region, a relation between time delay and both age and education level was observed.
CONCLUSION
The actual quality of care of patients with AMI in Bulgaria lies far from the evidence-based recommendations. Additional research and improvements in health services are needed to reduce the burden of cardiovascular disease in Bulgaria.
背景
心血管疾病是保加利亚的主要死因。由于保加利亚与其他欧洲国家在死亡率上存在显著差异，我们推测急性心肌梗死（AMI）的治疗方式存在明显差异，且循证治疗未得到充分利用。为了确定保加利亚急性心肌梗死患者的护理质量，我们分析了当前治疗的适宜性及其与患者特征的关系。
方法
我们进行了一项描述性横断面研究，使用从病历中回顾性收集的数据。纳入了2004年9月1日至12月31日期间居住在保加利亚旧扎戈拉地区并在当地医院住院的所有急性心肌梗死患者。在结构化患者访谈的框架内对社会经济状况进行了调查。我们使用带有费舍尔精确概率的卡方检验来分析患者的院前延迟时间、年龄、性别和社会经济状况之间的关系，并使用学生独立样本t检验来检验关于均值的假设。
结果
在134例急性心肌梗死患者中（平均年龄64.6岁，标准差13.2，66%为男性），7%在症状发作后59分钟内就诊，44%在4小时内就诊。肝素的使用率为98%。在最初24小时内，82%的病例使用了阿司匹林，73%的病例使用了β受体阻滞剂。出院时，阿司匹林、β受体阻滞剂、血管紧张素转换酶抑制剂或AR阻滞剂以及他汀类药物的使用率分别为85%、79%、66%和43%。32%符合条件的ST段抬高患者接受了静脉溶栓治疗。4例急性心肌梗死患者在发病后第一个月内接受了经皮冠状动脉介入治疗。医院位置与患者居住地的关系以及前往医院的交通方式并未影响症状发作至开始医院治疗之间的延迟时间。在研究区域，观察到延迟时间与年龄和教育水平之间存在关联。
结论
保加利亚急性心肌梗死患者的实际护理质量远未达到循证建议。需要进行更多研究并改善卫生服务，以减轻保加利亚心血管疾病的负担。
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