Roa Leonor, Monreal Manuel, Carmona José A, Aguilar Eduardo, Coll Ramón, Suárez Carmen
Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, España.
Med Clin (Barc). 2010 Jan 30;134(2):57-63. doi: 10.1016/j.medcli.2009.07.049. Epub 2009 Nov 13.
Although nowadays there are many cardiovascular disease (CVD) treatment protocols and evidence based guidelines, not many patients achieve the recommended levels for cardiovascular (CV) risk factor (RF) and management of disorders could be improved. Treatment inertia (TI) is the failure of health care providers to initiate or intensify therapy when indicated. The purpose of this study was to quantify TI in secondary CV prevention and identify factors influencing TI.
Observational, transversal study with 1660 patients included in FRENA (The FRENA registry recruited Spanish patients in CVD secondary prevention treated by different specialists), aged 66,3 years, 74% males, 38,5% females, 38,5% coronary heart disease (CHD), 30,8% cerebrovascular disease and 32% peripheral artery disease (PAD). Final variable: TI; three types of inertia where described: treatment failure inertia, RF control inertia and the third one was at least one of the previous. Uni and multivariate analysis were done for each type of inertia.
Inertia was detected in 81,5% of the patients. RF control inertia was 85,1% and treatment failure inertia 53%. Diabetic patients are likely to be treated with TI whereas patients with renal insufficiency (RI) or arterial hypertension (AHT) are more likely to be protected against it. There is less treatment failure inertia in cerebrovascular disease or coronary heart disease Vs PAD, AHT and Dyslipemia (DL) where the rate of treatment failure inertia is higher. RF control inertia increases with the coexistence of AHT, DL and diabetes mellitus (DM) and is lower in patients with previous CVD, cerebrovascular disease, AHT and DL.
In high risk patient, TI is present in a high percentage of them. DM, PAD and the coexistence of cardiovascular risk factors are associated with a higher inertia.
尽管如今有许多心血管疾病（CVD）治疗方案和循证指南，但实现心血管（CV）危险因素（RF）推荐水平的患者并不多，疾病管理仍有待改善。治疗惰性（TI）是指医疗保健提供者在有指征时未启动或强化治疗。本研究的目的是量化二级CV预防中的TI，并确定影响TI的因素。
对纳入FRENA（FRENA登记处招募了接受不同专科医生治疗的西班牙CVD二级预防患者）的1660例患者进行观察性横断面研究，患者年龄66.3岁，男性占74%，女性占38.5%，冠心病（CHD）占38.5%，脑血管疾病占30.8%，外周动脉疾病（PAD）占32%。最终变量：TI；描述了三种类型的惰性：治疗失败惰性、RF控制惰性，第三种是前两者中的至少一种。对每种类型的惰性进行单因素和多因素分析。
81.5%的患者存在惰性。RF控制惰性为85.1%，治疗失败惰性为53%。糖尿病患者更可能存在TI，而肾功能不全（RI）或动脉高血压（AHT）患者更可能避免TI。与PAD、AHT和血脂异常（DL）相比，脑血管疾病或冠心病患者的治疗失败惰性较小，而PAD、AHT和DL患者的治疗失败惰性发生率较高。RF控制惰性随着AHT、DL和糖尿病（DM）的共存而增加，在既往有CVD、脑血管疾病、AHT和DL的患者中较低。
在高危患者中，TI的发生率很高。DM、PAD以及心血管危险因素的共存与更高的惰性相关。
