Yeh Robert W, Go Alan S
Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Arch Intern Med. 2010 May 10;170(9):759-64. doi: 10.1001/archinternmed.2010.88.
During the previous decade, many strategies for preventing acute myocardial infarction found to be efficacious in randomized controlled trials have been adopted by physicians in the community. Although evaluations of quality improvement typically focus on process measures at the hospital, practice, or clinician level, assessment of improvements in health outcomes remains the true test for the successful translation of evidence into practice.
We performed a review of the current literature examining trends in the incidence of myocardial infarction in communities. We focused specifically on the group of population-based studies that have examined trends in myocardial infarction incidence.
Few population-based studies have examined recent temporal trends in the incidence of myocardial infarction, overall and by type. Existing studies have been largely limited by modest sample sizes, limited diversity within the study populations, the use of composite end points that combine disparate outcomes, and the inability to characterize the effect of long-term outpatient medication use on observed trends in incidence and severity of myocardial infarction.
More contemporary assessments of community-wide changes in the epidemiology of myocardial infarction are needed to help assess the effectiveness of primary prevention and to identify areas for potential improvement.
在过去十年间，社区医生采用了许多在随机对照试验中被证明有效的预防急性心肌梗死的策略。尽管质量改进评估通常侧重于医院、实践或临床医生层面的过程指标，但对健康结果改善情况的评估仍然是将证据成功转化为实践的真正检验。
我们对当前研究社区心肌梗死发病率趋势的文献进行了综述。我们特别关注了那些基于人群的研究组，这些研究考察了心肌梗死发病率的趋势。
很少有基于人群的研究考察心肌梗死发病率的近期时间趋势，包括总体趋势和按类型划分的趋势。现有研究在很大程度上受到样本量适中、研究人群多样性有限、使用将不同结果合并的复合终点以及无法描述长期门诊用药对观察到的心肌梗死发病率和严重程度趋势的影响等因素的限制。
需要对心肌梗死流行病学的全社区变化进行更当代的评估，以帮助评估一级预防的有效性，并确定潜在的改进领域。
