Huffman Mark D, Prabhakaran Dorairaj, Abraham Adangapuram Kurien, Krishnan Mangalath Narayanan, Nambiar Asokan Cheviri, Mohanan Padinhare Purayil
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Circ Cardiovasc Qual Outcomes. 2013 Jul;6(4):436-43. doi: 10.1161/CIRCOUTCOMES.113.000189. Epub 2013 Jun 25.
In-hospital and postdischarge treatment rates for acute coronary syndrome (ACS) remain low in India. However, little is known about the prevalence and associations of the package of optimal ACS medical care in India. Our objective was to define the prevalence, associations, and impact of optimal in-hospital and discharge medical therapy in the Kerala ACS Registry of 25,718 admissions.
We defined optimal in-hospital ACS medical therapy as receiving the following 5 medications: aspirin, clopidogrel, heparin, β-blocker, and statin. We defined optimal discharge ACS medical therapy as receiving all of the above therapies except heparin. Comparisons by optimal versus nonoptimal ACS care were made via Student t test for continuous variables and χ(2) test for categorical variables. We created random effects logistic regression models to evaluate the association between Global Registry of Acute Coronary Events risk score variables and optimal in-hospital or discharge medical therapy. Optimal in-hospital and discharge medical care were delivered in 40% and 46% of admissions, respectively. Wide variability in both in-hospital and discharge medical care was present, with few hospitals reaching consistently high (>90%) levels. Patients receiving optimal in-hospital medical therapy had an adjusted odds ratio (95% confidence interval)=0.93 (0.71, 1.22) for in-hospital death and an adjusted odds ratio (95% confidence interval)=0.79 (0.63, 0.99) for major adverse cardiovascular event rates. Patients who received optimal in-hospital medical care were far more likely to receive optimal discharge care (adjusted odds ratio [95% confidence interval] = 10.48 [9.37, 11.72]).
Strategies to improve in-hospital and discharge medical therapy are needed to improve local process-of-care measures and ACS outcomes in Kerala.
在印度，急性冠状动脉综合征（ACS）的住院治疗率和出院后治疗率仍然很低。然而，对于印度最佳ACS医疗护理方案的患病率和相关性知之甚少。我们的目标是在喀拉拉邦ACS登记处的25718例入院病例中确定最佳住院和出院药物治疗的患病率、相关性及影响。
我们将最佳住院ACS药物治疗定义为接受以下5种药物：阿司匹林、氯吡格雷、肝素、β受体阻滞剂和他汀类药物。我们将最佳出院ACS药物治疗定义为接受除肝素外的上述所有治疗。通过学生t检验对连续变量以及通过χ²检验对分类变量进行最佳与非最佳ACS护理的比较。我们创建了随机效应逻辑回归模型，以评估急性冠状动脉事件全球登记风险评分变量与最佳住院或出院药物治疗之间的关联。分别有40%和46%的入院病例接受了最佳住院和出院医疗护理。住院和出院医疗护理均存在很大差异，很少有医院能持续达到较高（>90%）水平。接受最佳住院药物治疗的患者住院死亡的调整优势比（95%置信区间）=0.93（0.71，1.22），主要不良心血管事件发生率的调整优势比（95%置信区间）=0.79（0.63，0.99）。接受最佳住院医疗护理的患者更有可能接受最佳出院护理（调整优势比[95%置信区间]=10.48[9.37，11.72]）。
需要采取策略改善住院和出院药物治疗，以改善喀拉拉邦当地的护理流程措施和ACS治疗结果。
