Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland, Herbert-Lewin-Platz 3, 10623 Berlin, Germany.
Dtsch Arztebl Int. 2011 Dec;108(50):856-62. doi: 10.3238/arztebl.2011.0856. Epub 2011 Dec 16.
Current guidelines recommend using aspirin, clopidogrel, beta-blockers, statins, and angiotensin converting enzyme (ACE) inhibitors after acute myocardial infarction (AMI). Although there is evidence that patients often stop taking these medications prematurely, long-term data reflecting the actual reality of care are lacking. We studied prescription prevalence and treatment persistence of secondary prevention in patients who had an AMI by analyzing relevant claims data from a German sickness fund, the Techniker Krankenkasse (these data are not necessarily representative of the entire German population).
Insurees who were discharged from the hospital between 2001 and 2006 with AMI as their main discharge diagnosis were classified as users or non-users of each of the types of drug listed above on the basis of the prescriptions that they obtained in the first 90 days after they left the hospital. Treatment persistence was statistically assessed with survival analysis. Switches from one drug class to another were not examined.
Of 30,028 AMI patients, 82% were initially prescribed a beta-blocker, 73% a statin, 69% an ACE inhibitor, 66% aspirin (without self-medication), and 61% clopidogrel. Five years after discharge, 10% of the patients for whom aspirin was initially prescribed were still taking it; the corresponding figures for the other drug classes were 17% for statins, 31% for ACE inhibitors, and 36% for beta-blockers. The greatest drop in treatment persistence occurred approximately one year after the AMI.
Treatment persistence with recommended medication after AMI is still in need of improvement. Patient education should start as soon as possible after infarction, because the greatest drops in medication use appear to occur within one year after AMI.
目前的指南建议在急性心肌梗死（AMI）后使用阿司匹林、氯吡格雷、β受体阻滞剂、他汀类药物和血管紧张素转换酶（ACE）抑制剂。尽管有证据表明患者经常过早停止服用这些药物，但缺乏反映实际护理情况的长期数据。我们通过分析德国 TK 健康保险公司（Techniker Krankenkasse）的相关索赔数据，研究了 AMI 患者的二级预防药物的处方流行率和治疗持久性。这些数据不一定代表整个德国人口。
根据出院后 90 天内开具的处方，我们将 2001 年至 2006 年期间因 AMI 为主诊断出院的参保人分为上述各类药物的使用者和非使用者。采用生存分析评估治疗持久性。未观察药物种类的转换。
在 30028 例 AMI 患者中，82%最初被开具β受体阻滞剂，73%开具他汀类药物，69%开具 ACE 抑制剂，66%开具阿司匹林（非自我用药），61%开具氯吡格雷。出院后 5 年，最初开具阿司匹林的患者中仍有 10%在服用该药；其他药物类别的相应比例为他汀类药物 17%，ACE 抑制剂 31%，β受体阻滞剂 36%。治疗持久性的最大下降发生在 AMI 后约 1 年。
AMI 后推荐药物的治疗持久性仍有待改善。应在梗塞后尽快开始对患者进行教育，因为药物使用的最大降幅似乎发生在 AMI 后 1 年内。
