Cordero Alberto, Bertomeu-Martínez Vicente, Mazón Pilar, Quiles Juan, Aznar Joaquín, Bueno Héctor
Departamento de Cardiología., Hospital Universitario de San Juan, Carretera Valencia-Alicante sn, 03550, San Juan de Alicante, Alicante, Spain.
Cardiovasc Ther. 2009 Fall;27(3):173-80. doi: 10.1111/j.1755-5922.2009.00093.x.
Coronary heart disease (CHD) patients are currently attended by many different medical specialities. CHD patients must achieve the highest grade of treatment implementation and risk factors control. The aims were to describe differences in medical treatment of CHD according to the medical specialities. For this purpose we conducted an observational, cross-sectional, and multicenter study of CHD patients attended by internal medicine (IM), outpatient clinic cardiologist (OCC), hospital cardiologist (HC), and general practitioners (PC). Burden of noncardiac diseases was evaluated by the Charlson index. Joint prescription of antiplatelets, statins, beta-blockade agents and blockade of the renin-angiotensin system by angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptors blockers (ARB) was considered optimal medical treatment (OMT). A total of 2987 patients, mean age 67.4 (11.5) years and 71.5% males, were analyzed. Patients visited by IM physicians had slightly higher mean age and higher prevalence of hypertension, diabetes, and noncardiac diseases (median Charlson index 3.0, 1.0-5.0, vs. 2.0, 1.0-4.0, of total sample). OMT was prescribed in 25.9% (95% CI 25.6-26.2) of the patients and was statistically more frequently carried out by HC (32.1%) and OCC (29.0%) compared to IM (22.0%) and PC practitioners (21.5%). Multivariate analysis showed an independent association between OMT prescription and HC (OR 1.42; 95% CI 1.08-1.87) or OCC (OR 1.31; 95% CI 1.04-1.67); this association remained after including the Charlson index. Noncardiac diseases are the main clinical differences in CHD patients visited by different medical specialist although it does not explain the higher prescription of OMT by cardiologist.
目前，冠心病（CHD）患者由许多不同的医学专科负责诊治。冠心病患者必须实现最高级别的治疗实施和危险因素控制。本研究旨在描述根据医学专科划分的冠心病医疗差异。为此，我们对在内科（IM）、门诊心脏病专家（OCC）、医院心脏病专家（HC）和全科医生（PC）处就诊的冠心病患者进行了一项观察性、横断面多中心研究。通过查尔森指数评估非心脏疾病负担。抗血小板药物、他汀类药物、β受体阻滞剂以及通过血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）对肾素 - 血管紧张素系统进行阻断的联合处方被视为最佳药物治疗（OMT）。共分析了2987例患者，平均年龄67.4（11.5）岁，男性占71.5%。由IM医生诊治的患者平均年龄略高，高血压、糖尿病和非心脏疾病的患病率更高（查尔森指数中位数为3.0，范围1.0 - 5.0，而总样本为2.0，范围1.0 - 4.0）。25.9%（95%CI 25.6 - 26.2）的患者接受了OMT治疗，与IM（22.0%）和PC医生（21.5%）相比，HC（32.1%）和OCC（29.0%）进行OMT治疗的比例在统计学上更高。多变量分析显示，OMT处方与HC（OR 1.42；95%CI 1.08 - 1.87）或OCC（OR 1.31；95%CI 1.04 - 1.67）之间存在独立关联；纳入查尔森指数后，这种关联仍然存在。非心脏疾病是不同医学专科诊治的冠心病患者的主要临床差异，尽管这并不能解释心脏病专家更高的OMT处方率。
