Arnold Suzanne V, Morrow David A, Lei Yang, Cohen David J, Mahoney Elizabeth M, Braunwald Eugene, Chan Paul S
Saint Luke's Mid America Heart Institute, Kansas City, MO 64111, USA.
Circ Cardiovasc Qual Outcomes. 2009 Jul;2(4):344-53. doi: 10.1161/CIRCOUTCOMES.108.829523. Epub 2009 Jun 2.
Angina in patients with coronary artery disease is associated with worse quality of life; however, the relationship between angina frequency and resource utilization is unknown.
Using data from the MERLIN-TIMI 36 trial, we assessed the association between the extent of angina after an acute coronary syndrome (ACS) and subsequent cardiovascular resource utilization among 5460 stable outpatients who completed the Seattle Angina Questionnaire at 4 months after an ACS and who were then followed for an additional 8 months. Angina frequency was categorized as none (score, 100; 2739 patients), monthly (score, 61 to 99; 1608 patients), weekly (score, 31 to 60; 854 patients), and daily (score, 0 to 30; 259 patients). Multivariable regression models evaluated the association between angina frequency and overall costs attributable to cardiovascular hospitalizations, outpatient visits and procedures, and medications. As compared with no angina, overall costs increased in a graded fashion with higher angina frequency-no angina, $2928 (reference); monthly angina, $3909 (adjusted relative cost ratio, 1.29; 95% CI, 1.21 to 1.39); weekly angina, $4558 (adjusted relative cost ratio, 1.52; 95% CI, 1.48 to 1.67); and daily angina, $6949 (adjusted relative cost ratio, 2.32; 95% CI, 2.01 to 2.69; P for trend <0.001). Differences in costs were attributable primarily to higher rates of ACS hospitalization and coronary revascularization among patients with more severe angina.
Among stable outpatients after ACS, a direct graded relationship was found between higher angina frequency and healthcare costs. As compared with patients without angina, patients with daily angina had a >2-fold increase in resource utilization and incremental costs of $4000 after 8 months of follow-up.
冠心病患者的心绞痛与生活质量较差相关；然而，心绞痛发作频率与资源利用之间的关系尚不清楚。
利用MERLIN-TIMI 36试验的数据，我们评估了急性冠状动脉综合征（ACS）后心绞痛程度与随后心血管资源利用之间的关联，这些研究对象为5460名稳定的门诊患者，他们在ACS后4个月完成了西雅图心绞痛问卷，随后又随访了8个月。心绞痛发作频率分为无（得分100；2739例患者）、每月发作（得分61至99；1608例患者）、每周发作（得分31至60；854例患者）和每日发作（得分0至30；259例患者）。多变量回归模型评估了心绞痛发作频率与心血管住院、门诊就诊及手术和药物治疗所致的总费用之间的关联。与无心绞痛相比，总费用随着心绞痛发作频率的升高而呈梯度增加——无心绞痛，2928美元（参照）；每月发作心绞痛，3909美元（调整后相对成本比，1.29；95%CI，1.21至1.39）；每周发作心绞痛，4558美元（调整后相对成本比，1.52；95%CI，1.48至1.67）；每日发作心绞痛，6949美元（调整后相对成本比，2.32；95%CI，2.01至2.69；趋势P<0.001）。费用差异主要归因于心绞痛更严重患者中较高的ACS住院率和冠状动脉血运重建率。
在ACS后的稳定门诊患者中，发现心绞痛发作频率升高与医疗费用之间存在直接的梯度关系。与无心绞痛的患者相比，每日发作心绞痛的患者在随访8个月后资源利用增加了2倍多，增量成本为4000美元。
