Hoeks Sanne E, Scholte op Reimer Wilma J M, van Gestel Yvette R B M, Schouten Olaf, Lenzen Mattie J, Flu Willem-Jan, van Kuijk Jan-Peter, Latour Corine, Bax Jeroen J, van Urk Hero, Poldermans Don
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Circ Cardiovasc Qual Outcomes. 2009 Jul;2(4):338-43. doi: 10.1161/CIRCOUTCOMES.109.868505. Epub 2009 Apr 24.
Patients with peripheral arterial disease constitute a high-risk population. Guideline-recommended medical therapy use is therefore of utmost importance. The aims of our study were to establish the patterns of guideline-recommended medication use in patients with PAD at the time of vascular surgery and after 3 years of follow up, and to evaluate the effect of these therapies on long-term mortality in this patient group.
Data on 711 consecutive patients with peripheral arterial disease undergoing vascular surgery were collected from 11 hospitals in the Netherlands (enrollment between May and December 2004). After 3.1+/-0.1 years of follow-up, information on medication use was obtained by a questionnaire (n=465; 84% response rate among survivors). Guideline-recommended medical therapy use for the combination of aspirin and statins in all patients and beta-blockers in patients with ischemic heart disease was 41% in the perioperative period. The use of perioperative evidence-based medication was associated with a reduction of 3-year mortality after adjustment for clinical characteristics (hazard ratio, 0.65; 95% CI, 0.45 to 0.94). After 3 years of follow-up, aspirin was used in 74%, statins in 69%, and beta-blockers in 54% of the patients respectively. Guideline-recommended medical therapy use for the combination of aspirin, statins, and beta-blockers was 50%.
The use of guideline recommended therapies in the perioperative period was associated with reduction in long-term mortality in patients with peripheral arterial disease. However, the proportion of patients receiving these evidence-based treatments-both at baseline and 3 years after vascular surgery-was lower than expected based on the current guidelines. These data highlight a clear opportunity to improve the quality of care in this high-risk group of patients.
外周动脉疾病患者属于高危人群。因此，遵循指南推荐的药物治疗至关重要。我们研究的目的是确定血管手术时及随访3年后外周动脉疾病患者遵循指南推荐用药的模式，并评估这些治疗对该患者群体长期死亡率的影响。
从荷兰11家医院收集了711例连续接受血管手术的外周动脉疾病患者的数据（2004年5月至12月入组）。经过3.1±0.1年的随访，通过问卷调查获得用药信息（n = 465；幸存者中的应答率为84%）。在围手术期，所有患者联合使用阿司匹林和他汀类药物以及缺血性心脏病患者使用β受体阻滞剂的指南推荐药物治疗使用率为41%。在对临床特征进行调整后，围手术期使用基于证据的药物与3年死亡率降低相关（风险比，0.65；95%可信区间，0.45至0.94）。随访3年后，分别有74%的患者使用阿司匹林，69%的患者使用他汀类药物，54%的患者使用β受体阻滞剂。阿司匹林、他汀类药物和β受体阻滞剂联合使用的指南推荐药物治疗使用率为50%。
围手术期使用指南推荐的治疗方法与外周动脉疾病患者长期死亡率降低相关。然而，无论是在基线时还是血管手术后3年，接受这些基于证据治疗的患者比例均低于当前指南预期。这些数据凸显了改善这一高危患者群体护理质量的明显机会。
