1996-2006 年十年间医院实践中的冠心病二级预防。克拉科夫缺血性心脏病二级预防方案和 EUROASPIRE II 及 EUROASPIRE III 调查波兰部分的结果。

Secondary prevention of coronary artery disease in hospital practice over the decade 1996-2006. Results of the Cracovian Program for Secondary Prevention of Ischaemic Heart Disease and Polish parts of the EUROASPIRE II and EUROASPIRE III surveys.

机构信息

1st Department of Cardiology and Hypertension, Jagiellonian University Collegium Medicum, Krakow, Poland.

出版信息

Kardiol Pol. 2009 Aug;67(8A):970-7.

PMID:19784901

Abstract

BACKGROUND

Both in the European and Polish guidelines the highest priority for preventive cardiology was given to patients with established cardiovascular disease. The Cracovian Program for Secondary Prevention of Ischaemic Heart Disease was initiated in 1996. The main goal of the program was to assess and improve the quality of clinical care in the secondary prevention of ischaemic heart disease. Later, the same centres joined the EUROASPIRE (European Action on Secondary and Primary Prevention Intervention to Reduce Events) II and III surveys.

AIM

To compare the quality of secondary prevention in Krakow cardiac departments in 1996/1997, 1998/1999 and 2005/2006.

METHODS

Five hospitals serving the area of the city of Krakow and surrounding districts (former Krakow Voivodship), inhabited by 1,200,000 persons, took part in the surveys. Consecutive patients hospitalised from July 1, 1996 to September 31, 1997 (first survey), from March 1, 1998 to March 30, 1999 (second survey), and from April 1, 2005 to July 31, 2006 (third survey) due to acute myocardial infarction, unstable angina or for myocardial revascularisation procedures, below the age of <71 years were recruited and included to the present analysis. All medical records were reviewed by trained reviewers using standardised data collection forms.

RESULTS

Medical records of 536 patients treated in 1996/1997, 515 treated 1998/1999, and 540 treated in 2005/2006 were reviewed and analysed. Proportions of medical records with available information on risk factors prior to hospitalisation as well as proportions of medical records with available information on blood pressure (by 10%, p < 0.05) and lipids (by over 30%, p < 0.05) measurements during the first 24 h of hospitalisation as well as on weight and height measurements (by 16%, p < 0.05) increased significantly from 1996/1997 to 2005/2006. Antiplatelets prescription rate at discharge increased from 87% to 97% (p < 0.05), prescription rate for beta-blockers increased from 66% to 91% (p < 0.05), ACE inhibitors/sartans from 50% to 89% (p < 0.05), and lipid lowering drugs from 27% to 96% (p < 0.05) between 1996/1997 and 2005/2006, respectively.

CONCLUSIONS

The implementation of secondary prevention guidelines into clinical practice in the Krakow cardiac departments improved in 2005/2006 as compared to 1996/1997 and 1998/1999. Our results suggest that recent decade brought significant improvement in the approach to secondary prevention of ischaemic heart disease in hospital practice.

摘要

背景

在欧洲和波兰的指南中，预防心脏病学的最高优先级都给予了已患有心血管疾病的患者。1996 年启动了克拉科夫缺血性心脏病二级预防计划。该计划的主要目标是评估和改善缺血性心脏病二级预防的临床护理质量。后来，相同的中心加入了 EUROASPIRE（欧洲二级和初级预防干预以减少事件）II 和 III 调查。

目的

比较 1996/1997 年、1998/1999 年和 2005/2006 年克拉科夫心脏科的二级预防质量。

方法

五个为克拉科夫市及周边地区（前克拉科夫省）服务的医院参与了调查，该地区有 120 万居民。连续收治因急性心肌梗死、不稳定型心绞痛或接受心肌血运重建手术于 1996 年 7 月 1 日至 1997 年 9 月 31 日（第一次调查）、1998 年 3 月 1 日至 1999 年 3 月 30 日（第二次调查）和 2005 年 4 月 1 日至 2006 年 7 月 31 日（第三次调查）的患者。招募年龄<71 岁的患者，并将其纳入本分析。所有病历均由经过培训的评审员使用标准化数据收集表进行审查。

结果

对 1996/1997 年治疗的 536 名患者、1998/1999 年治疗的 515 名患者和 2005/2006 年治疗的 540 名患者的病历进行了回顾和分析。与 1996/1997 年相比，1998/1999 年和 2005/2006 年有更多病历记录了住院前危险因素信息（分别增加了 10%和超过 30%，p<0.05），有更多病历记录了住院 24 小时内的血压（增加了 10%，p<0.05）和血脂（增加了超过 30%，p<0.05）测量值，以及体重和身高测量值（增加了 16%，p<0.05）。出院时抗血小板药物的处方率从 87%增加到 97%（p<0.05），β受体阻滞剂的处方率从 66%增加到 91%（p<0.05），ACE 抑制剂/沙坦类药物从 50%增加到 89%（p<0.05），降脂药物从 27%增加到 96%（p<0.05）。