Pirraglia Paul A, Taveira Tracey H, Cohen Lisa B, Dooley Andrea, Wu Wen-Chih
Systems, Outcomes, and Quality in Chronic Disease and Rehabilitation (SOQCR) Program, Providence VA Medical Center, 830 Chalkstone Avenue, Building T32, Providence, RI 02908-4799, USA.
Prev Cardiol. 2009 Winter;12(1):3-8. doi: 10.1111/j.1751-7141.2008.00017.x.
The authors evaluated maintenance of achieved cardiovascular risk control after discharge from a pharmacist-coordinated cardiovascular risk reduction clinic. Using data from 2001 to 2004 divided by financial quarters (ie, 3-month periods), the authors performed survival analysis of diabetic patients who had attained at least one cardiovascular risk goal in the clinic. Mean times to failure were 7.1 +/- 0.21 quarters for hemoglobin A1c, 7.6 +/- 0.29 quarters for low-density lipoprotein cholesterol (LDL-C), and 2.5 +/- 0.24 quarters for systolic blood pressure (SBP). Body mass index predicted glycemic control failure (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.01-1.15; P = .02), insulin use predicted LDL-C control failure (HR, 3.08; 95% CI, 1.15-8.22; P = .03), and baseline SBP predicted SBP control failure (HR, 1.02; 95% CI, 1.01-1.03; P = .0003). The authors found good durability of effect for most cardiovascular risk targets. Worse control at entry predicted failure after successful attainment of a cardiovascular goal. More sustained attention or booster interventions for patients with worse control at entry may be necessary.
作者评估了从药剂师协调的心血管风险降低诊所出院后已实现的心血管风险控制的维持情况。作者利用2001年至2004年按财政季度（即3个月时间段）划分的数据，对在诊所中至少实现一个心血管风险目标的糖尿病患者进行了生存分析。糖化血红蛋白控制失败的平均时间为7.1±0.21个季度，低密度脂蛋白胆固醇（LDL-C）为7.6±0.29个季度，收缩压（SBP）为2.5±0.24个季度。体重指数可预测血糖控制失败（风险比[HR]，1.08；95%置信区间[CI]，1.01 - 1.15；P = 0.02），胰岛素使用可预测LDL-C控制失败（HR，3.08；95%CI，1.15 - 8.22；P = 0.03），基线SBP可预测SBP控制失败（HR，1.02；95%CI，1.01 - 1.03；P = 0.0003）。作者发现大多数心血管风险目标的疗效具有良好的持久性。入院时控制较差可预测成功实现心血管目标后的失败。对于入院时控制较差的患者，可能需要更持续的关注或强化干预措施。
