印度初级和二级医疗保健中他汀类药物及其他冠心病二级预防疗法的低使用率。
Low use of statins and other coronary secondary prevention therapies in primary and secondary care in India.
作者信息
Sharma Krishna K, Gupta Rajeev, Agrawal Aachu, Roy Sanjeeb, Kasliwal Atul, Bana Ajeet, Tongia Ravindra K, Deedwania Prakash C
机构信息
Department of Pharmacy, LBS College of Pharmacy, Jaipur, India.
出版信息
Vasc Health Risk Manag. 2009;5:1007-14. doi: 10.2147/vhrm.s8017. Epub 2009 Nov 23.
OBJECTIVE
To determine the frequency of use of pharmacotherapy with aspirin, beta blocker, statin, and angiotensin-converting enzyme (ACE) inhibitor in patients with stable coronary heart disease (CHD) among physicians at different levels of health care in Rajasthan state, India.
METHODS
Physicians practicing at tertiary hospitals and clinics at tertiary, secondary and primary levels were contacted. Prescriptions of CHD patients were audited and descriptive statistics reported.
RESULTS
We evaluated 2,993 prescriptions (tertiary hospital discharge 711, tertiary 688, secondary 1,306, and primary 288). Use of aspirin was in 2,713 (91%) of prescriptions, beta blockers 2,057 (69%), ACE inhibitors or angiotensin receptor blockers (ARBs) 2,471 (82%), and statins 2,059 (69%). Any one of these drugs was prescribed in 2,991 (100%), any two in 2,880 (96%), any three in 1,740 (58%), and all four in 1,062 (35.5%) (P < 0.001). As compared to tertiary hospital, prescriptions at tertiary, secondary, and primary levels were lower: aspirin (96% vs 95%, 91%, 67%), beta blockers (80% vs 62%, 66%, 70%), statins (87% vs 82%, 62%, 21%): two drugs (98% vs 96%, 98%, 85%), three drugs (75% vs 58%, 55%, 28%), or four drugs (54% vs 44%, 28%, 7%) (P < 0.01). Use of ACE inhibitors/ARBs was similar while nitrates (43% vs 23%, 43%, 70%), dihydropyridine calcium channel blockers (12% vs 15%, 30%, 47%), and multivitamins (6% vs 26%, 37%, 47%) use was more in secondary and primary care.
CONCLUSIONS
There is suboptimal use of various evidence-based drugs (aspirin, beta blockers, ACE inhibitors, and statins) for secondary prevention of CHD in India.
目的
确定印度拉贾斯坦邦不同医疗水平的医生对稳定型冠心病（CHD）患者使用阿司匹林、β受体阻滞剂、他汀类药物和血管紧张素转换酶（ACE）抑制剂进行药物治疗的频率。
方法
联系在三级医院以及三级、二级和一级诊所执业的医生。审核冠心病患者的处方并报告描述性统计数据。
结果
我们评估了2993份处方（三级医院出院处方711份，三级医疗机构688份，二级医疗机构1306份，一级医疗机构288份）。2713份（91%）处方使用了阿司匹林，2057份（69%）使用了β受体阻滞剂，2471份（82%）使用了ACE抑制剂或血管紧张素受体阻滞剂（ARB），2059份（69%）使用了他汀类药物。这些药物中的任何一种被开出处方的有2991份（100%），任何两种的有2880份（96%），任何三种的有1740份（58%），四种都有的有1062份（35.5%）（P<0.001）。与三级医院相比，三级、二级和一级医疗机构的处方比例较低：阿司匹林（96%对95%、91%、67%），β受体阻滞剂（80%对62%、66%、70%），他汀类药物（87%对82%、62%、21%）：两种药物（98%对96%、98%、85%），三种药物（75%对58%、55%、28%），或四种药物（54%对44%、28%、7%）（P<0.01）。ACE抑制剂/ARB的使用情况相似，而硝酸盐（43%对23%、43%、70%）、二氢吡啶类钙通道阻滞剂（12%对15%、30%、47%）和多种维生素（6%对26%、37%、47%）在二级和一级医疗保健中的使用更为普遍。
结论
在印度，用于冠心病二级预防的各种循证药物（阿司匹林、β受体阻滞剂、ACE抑制剂和他汀类药物）的使用并不理想。
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