Pinnarelli Luigi, Mayer Flavia, Bauleo Lisa, Agabiti Nera, Kirchmayer Ursula, Belleudi Valeria, Di Martino Mirko, Autore Camillo, Ricci Roberto, Violini Roberto, Fusco Danilo, Davoli Marina, Perucci Carlo A
aDepartment of Epidemiology, Lazio Regional Health Service bDivisione di Cardiologia, Università di Roma La Sapienza, Ospedale Sant'Andrea cDepartment of Cardiology, St Spirito Hospital dDepartment of Interventional Cardiology, Azienda Ospedaliera San Camillo Forlanini eNational Agency for Regional Health Services, Rome, Italy.
J Cardiovasc Med (Hagerstown). 2015 Mar;16(3):230-7. doi: 10.2459/JCM.0000000000000070.
We evaluated adherence to dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for patients in the Lazio region of Italy and the impact of discharge ward type on therapy discontinuation.
From the Hospital Information System, we selected patients who underwent PCI from 2006 to 2007 and obtained Regional Drug Dispense Registry data for antiplatelet drugs prescribed for 12 months after discharge. Appropriate therapy was defined as DAPT with prescribed daily doses for each drug covering at least 75% of each individual follow-up period. The association between discharge ward type and antiplatelet therapy adherence at 12 months post discharge was estimated using multilevel logistic regression analysis.
A total of 11 186 patients with PCI were included, and fewer than half (4984; 44.56%) were on adequate DAPT. Only 2930 of 5390 patients (54.36%) with DAPT in the first 6 months post discharge continued DAPT in the second 6 months. Patients discharged from cardiology units or intensive coronary care units were more likely (odds ratio = 1.26; P = 0.003) to receive appropriate antiplatelet therapy, and elderly patients were less likely (odds ratio = 0.65; P < 0.001) to do so.
The proportion of PCI patients receiving appropriate DAPT after discharge is suboptimal in this region, and elderly patients are less likely to receive appropriate therapy. These findings could be important for improving patient management and ensuring adherence to clinical guidelines and indicate the need for a systematic evaluation of the appropriateness of postdischarge therapy.
我们评估了意大利拉齐奥地区接受经皮冠状动脉介入治疗（PCI）患者对双联抗血小板治疗（DAPT）的依从性以及出院病房类型对治疗中断的影响。
从医院信息系统中，我们选取了2006年至2007年接受PCI的患者，并获取了出院后12个月开具的抗血小板药物的地区药物配给登记数据。适当治疗定义为使用每种药物规定的每日剂量进行DAPT，且每种药物至少覆盖每个个体随访期的75%。使用多水平逻辑回归分析评估出院病房类型与出院后12个月抗血小板治疗依从性之间的关联。
共纳入11186例PCI患者，接受适当DAPT治疗的患者不到一半（4984例；44.56%）。出院后前6个月接受DAPT治疗的5390例患者中，只有2930例（54.36%）在接下来的6个月继续接受DAPT治疗。从心脏病科或重症冠心病监护病房出院的患者更有可能（优势比=1.26；P=0.003）接受适当的抗血小板治疗，而老年患者接受适当治疗的可能性较小（优势比=0.65；P<0.001）。
该地区PCI患者出院后接受适当DAPT治疗的比例不理想，老年患者接受适当治疗的可能性较小。这些发现对于改善患者管理和确保遵循临床指南可能很重要，并表明需要对出院后治疗的适当性进行系统评估。
