年龄、痴呆症与急性冠状动脉综合征入院后的照护模式：全民健康保险覆盖下的全国性队列分析。
Age, dementia and care patterns after admission for acute coronary syndrome: an analysis from a nationwide cohort under the National Health Insurance coverage.
机构信息
School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
出版信息
Drugs Aging. 2012 Oct;29(10):819-28. doi: 10.1007/s40266-012-0011-6.
BACKGROUND
The number of elderly and the prevalence of dementia have grown considerably in recent years. Little is known about how aging and dementia affect care patterns after discharge for acute coronary syndrome (ACS).
OBJECTIVE
This study was designed to assess the impact of dementia on care patterns after admission for patients with ACS across different age groups.
METHODS
Of 87,321 patients hospitalized for ACS between 1 January 2006 and 31 December 2007, 1,835 patients with dementia and 3,670 matched patients without dementia (1:2 ratio, matched by age, sex and hospital level) were identified from Taiwan's National Health Insurance Research Database. Use of interventional therapies at hospitalization and guideline-recommended medications post-discharge were compared between patients with and without dementia across different age groups (≤65, 66-75, 76-85, ≥86 years). Multivariate logistic regression models were performed to examine the impact of dementia on care patterns.
RESULTS
Overall, dementia was associated with a 27% lower likelihood of receipt of interventional therapies [adjusted odds ratio (OR) = 0.73; 95% CI 0.63, 0.83] and a 22% lower likelihood of guideline-recommended medications (adjusted OR = 0.78; 95% CI 0.68, 0.89) in ACS patients. The use of interventional therapies and guideline-recommended medications decreased with age, and interactions between age and dementia were found. The proportions of patients receiving interventional therapies were 39.4% (without dementia) versus 21.8% (with dementia) in the youngest age group and 18.6% (without dementia) versus 14.5% (with dementia) in the oldest age group. Patients with dementia (age ≤65 years 73.6%; age 66-75 years 82.3%; age 76-85 years 71.8%; age ≥86 years 55.6%) were less likely to receive guideline-recommended medications as compared with those without dementia (age ≤65 years 85.6%; age 66-75 years 87.5%; age 76-85 years 81.2%; age ≥86 years 62.0%).
CONCLUSION
Dementia and aging were associated with decreased use of interventional therapies and guideline-recommended medications in ACS patients.
背景
近年来，老年人的数量和痴呆症的患病率显著增加。对于痴呆症如何影响急性冠状动脉综合征（ACS）出院后的护理模式知之甚少。
目的
本研究旨在评估痴呆症对不同年龄组 ACS 患者入院后护理模式的影响。
方法
从台湾全民健康保险研究数据库中，确定了 2006 年 1 月 1 日至 2007 年 12 月 31 日期间因 ACS 住院的 87321 例患者中，1835 例痴呆症患者和 3670 例匹配的无痴呆症患者（1:2 比例，按年龄、性别和医院级别匹配）。比较了不同年龄组（≤65 岁、66-75 岁、76-85 岁、≥86 岁）患者中痴呆症与非痴呆症患者的住院期间介入治疗和出院后指南推荐药物的使用情况。采用多变量逻辑回归模型分析痴呆症对护理模式的影响。
结果
总体而言，痴呆症患者接受介入治疗的可能性降低了 27%[调整后的优势比（OR）=0.73；95%置信区间（CI）0.63，0.83]，指南推荐药物的可能性降低了 22%（调整后的 OR=0.78；95% CI 0.68，0.89）。ACS 患者接受介入治疗和指南推荐药物的比例随年龄增长而降低，且年龄与痴呆症之间存在交互作用。在最年轻的年龄组中，接受介入治疗的患者比例为 39.4%（无痴呆症）与 21.8%（有痴呆症），在最年长的年龄组中，这一比例为 18.6%（无痴呆症）与 14.5%（有痴呆症）。与无痴呆症患者相比，痴呆症患者（年龄≤65 岁 73.6%；年龄 66-75 岁 82.3%；年龄 76-85 岁 71.8%；年龄≥86 岁 55.6%）接受指南推荐药物的可能性更低（年龄≤65 岁 85.6%；年龄 66-75 岁 87.5%；年龄 76-85 岁 81.2%；年龄≥86 岁 62.0%）。
结论
痴呆症和年龄与 ACS 患者介入治疗和指南推荐药物的使用减少有关。
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