Buja Alessandra, Boemo Deris Gianni, Furlan Patrizia, Bertoncello Chiara, Casale Patrizia, Baldovin Tatjana, Marcolongo Adriano, Baldo Vincenzo
University of Padua, Padua, Italy.
Eur J Prev Cardiol. 2014 Feb;21(2):222-30. doi: 10.1177/2047487312462148. Epub 2012 Sep 20.
Mortality due to coronary heart disease has been declining as a result of better clinical patient management, including secondary prevention with the aid of effective drugs. The clinical challenge remains how to improve adherence to evidence-based cardiac care for all patients who can benefit from it. The present study aimed to assess the effectiveness of drug use after acute myocardial infarction (AMI) in reducing total medium-term mortality and to establish whether there are disparities in prescribing all therapies of demonstrated effectiveness.
We conducted a retrospective cohort study between 2002 and 2009 using a record linkage database, considering 1327 patients discharged after AMI.
Cox's regression models were used for the survival analysis with time-dependent variables. Logistic regression analyses were performed to investigate the inequalities in the actual use of therapies found significantly associated with a lower mortality in the survival analyses.
Therapies independently associated with a lower all-cause mortality risk were antiplatelet drugs, beta-blockers, angiotensin-converting enzyme inhibitors, and statins. Gender-related differences in prescriptions were seen for statins and antiplatelet drugs; age-related differences emerged for all drugs. Associated chronic obstructive pulmonary disease reduced the likelihood of patients taking the effective treatments.
The present study revealed disparities in the use of treatments for the secondary prevention of coronary heart disease unjustifiable on the strength of clinical evidence.
由于临床患者管理的改善，包括借助有效药物进行二级预防，冠心病死亡率一直在下降。临床面临的挑战仍然是如何提高所有能从中受益的患者对循证心脏护理的依从性。本研究旨在评估急性心肌梗死（AMI）后药物使用在降低中期总死亡率方面的有效性，并确定在开具所有已证实有效的治疗药物时是否存在差异。
我们使用记录链接数据库在2002年至2009年期间进行了一项回顾性队列研究，纳入了1327例AMI后出院的患者。
采用Cox回归模型进行生存分析，纳入时间依赖性变量。进行逻辑回归分析，以研究在生存分析中发现与较低死亡率显著相关的治疗实际使用情况中的不平等现象。
与较低全因死亡风险独立相关的治疗药物为抗血小板药物、β受体阻滞剂、血管紧张素转换酶抑制剂和他汀类药物。他汀类药物和抗血小板药物在处方方面存在性别差异；所有药物在处方上均出现了年龄差异。合并慢性阻塞性肺疾病降低了患者接受有效治疗的可能性。
本研究揭示了冠心病二级预防治疗使用方面的差异，这些差异在临床证据方面是不合理的。
