Hess Gregory, Preblick Ronald, Hill Jerrold, Plauschinat Craig A, Yaskin Joseph
Surveillance Data Inc., Germantown Pike, Plymouth Meeting, PA 19462, USA.
Congest Heart Fail. 2009 Jul-Aug;15(4):170-5. doi: 10.1111/j.1751-7133.2009.00092.x.
American College of Cardiology/American Heart Association guidelines recommend angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy following acute myocardial infarction (MI) or development of heart failure (HF). This study estimated the effects of initiating these therapies after hospitalization for MI or HF on subsequent 1-year rehospitalization rates for MI or HF. A retrospective multivariate analysis of medical claims for 14,327 patients receiving and 7905 not receiving an ACEI or ARB after discharge for MI or HF was conducted. Rehospitalization for MI or HF was lower for treated vs untreated patients (MI: odds ratio [OR]=0.53, P<.001; HF: OR=0.52, P<.001). Rehospitalization was lower in treated patients with high medication compliance (medication possession ratio [MPR]>80%) and medium compliance (MPR 40%-79%) vs patients with low compliance (ORs for MI: high=0.54, medium=0.69; P<.001); ORs for HF: high=0.38, medium=0.62; P<.001). In conclusion, ACEI or ARB therapy initiated after hospitalization for MI or HF reduced risk of rehospitalization, and greater risk reduction was achieved with higher medication compliance.
美国心脏病学会/美国心脏协会指南推荐，在急性心肌梗死（MI）或心力衰竭（HF）发生后使用血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）进行治疗。本研究评估了MI或HF住院后开始这些治疗对随后1年MI或HF再住院率的影响。对14327例MI或HF出院后接受ACEI或ARB治疗的患者以及7905例未接受治疗的患者的医疗索赔进行了回顾性多变量分析。与未治疗的患者相比，接受治疗的患者MI或HF再住院率更低（MI：比值比[OR]=0.53，P<0.001；HF：OR=0.52，P<0.001）。与依从性低的患者相比，药物依从性高（药物持有率[MPR]>80%）和依从性中等（MPR 40%-79%）的接受治疗患者再住院率更低（MI的OR：高依从性=0.54，中等依从性=0.69；P<0.001）；HF的OR：高依从性=0.38，中等依从性=0.62；P<0.001）。总之，MI或HF住院后开始ACEI或ARB治疗可降低再住院风险，且药物依从性越高，风险降低幅度越大。
