Técnicas Avanzadas de Investigación en Servicios de Salud, Madrid, España.
Rev Esp Cardiol. 2010 Dec;63(12):1428-37. doi: 10.1016/s1885-5857(10)70277-2.
Studies indicate that dyslipidemia is undertreated. Numerous systematic reviews have shown that, even when therapeutic targets set by clinical practice guidelines have not been met, treatment remains unchanged despite the availability of alternatives approaches. The result is increased morbidity and mortality. Our aims were to investigate this phenomenon, known as therapeutic inertia, in patients with dyslipidemia and ischemic heart disease, and to determine its possible causes.
national, multicenter, observational study of data obtained from physicians by questionnaire and from the clinical records of patients with ischemic heart disease. Main variable: therapeutic inertia during a consultation, defined as treatment remaining the same despite a change being indicated (e.g. low-density lipoprotein cholesterol >100 mg/dl or >70 mg/dl in diabetics). Covariates: physician, patient and consultation characteristics.
multivariate logistic regression analysis of factors associated with therapeutic inertia during a consultation.
Overall, 43% of consultations involved therapeutic inertia, and an association with coronary risk factors, including diabetes, did not result in a change in treatment. Therapeutic inertia occurred more frequently when there was a long time between the diagnosis and treatment of dyslipidemia and that of ischemic heart disease. Undertreatment was particularly common in women despite a greater overall risk. The more experienced physicians treated younger patients more appropriately. Clinical practice was improved by educational sessions at conferences.
Therapeutic inertia was common in patients with chronic ischemic heart disease and dyslipidemia, irrespective of overall cardiovascular risk. Factors associated with the patient, disease and physician had an influence.
研究表明血脂异常治疗不足。许多系统评价表明，即使临床实践指南设定的治疗目标未达到，也会不顾有替代方法，而保持治疗不变。其结果是发病率和死亡率增加。我们的目的是研究这种称为治疗惰性的现象，即在血脂异常和缺血性心脏病患者中，并确定其可能的原因。
全国性、多中心、观察性研究，通过问卷和缺血性心脏病患者的临床记录收集医生的数据。主要变量：咨询期间的治疗惰性，定义为尽管需要改变（例如，低密度脂蛋白胆固醇> 100mg/dl 或糖尿病患者> 70mg/dl）但治疗保持不变。协变量：医生、患者和咨询特点。
对与咨询期间治疗惰性相关的因素进行多变量逻辑回归分析。
总体而言，43%的咨询涉及治疗惰性，与冠心病危险因素（包括糖尿病）相关，但并未导致治疗改变。在血脂异常和缺血性心脏病的诊断和治疗之间的时间间隔较长时，治疗惰性更常见。尽管总体风险较高，但女性的治疗不足更为常见。经验丰富的医生对年轻患者的治疗更为恰当。会议上的教育课程改善了临床实践。
在患有慢性缺血性心脏病和血脂异常的患者中，治疗惰性很常见，与总体心血管风险无关。与患者、疾病和医生相关的因素有影响。
