Kumbhani Dharam J, Fonarow Gregg C, Cannon Christopher P, Hernandez Adrian F, Peterson Eric D, Peacock W Frank, Laskey Warren K, Deedwania Prakash, Grau-Sepulveda Maria, Schwamm Lee H, Bhatt Deepak L
Division of Cardiology, University of Texas Southwestern Medical Center, Dallas.
UCLA Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, Calif.
Am J Med. 2015 Apr;128(4):426.e1-9. doi: 10.1016/j.amjmed.2014.11.013. Epub 2014 Nov 26.
Prior studies have noted that in-hospital adherence to secondary prevention measures varied among patients undergoing coronary artery bypass graft surgery, percutaneous coronary revascularization, or no intervention. We sought to study contemporary temporal trends in the in-hospital management of patients with coronary artery disease.
By using data from the Get With The Guidelines-Coronary Artery Disease registry, we compared adherence to 6 performance measures (aspirin within 24 hours, discharge on aspirin, discharge on beta-blockers, patients with low ejection fraction discharged on angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, smoking cessation counseling, and use of lipid-lowering medications) in eligible patients with coronary artery disease who underwent coronary artery bypass graft surgery, percutaneous coronary intervention, or no intervention between 2003 and 2008.
A total of 113,971 patients with coronary artery disease were treated at 193 hospitals. Overall adherence to all 6 quality of care measures improved over time in all 3 treatment groups, but was highest at all time periods in the percutaneous coronary intervention group compared with the coronary artery bypass graft surgery group, whereas the no intervention group had the lowest use of prevention measures at all time points (P < .0001). Likewise, 100% adherence to all 6 measures was superior in the percutaneous coronary intervention group at all time points (P < .0001). On multivariable adjustment for case-mix of patients, the majority of these differences persisted.
Over the last decade, overall adherence with secondary prevention measures improved significantly in patients hospitalized with coronary artery disease regardless of revascularization strategy. However, there still exist select opportunities for improving adherence, particularly among patients undergoing coronary artery bypass graft surgery or no intervention.
先前的研究指出，在接受冠状动脉搭桥手术、经皮冠状动脉血运重建或未接受干预的患者中，住院期间二级预防措施的依从性存在差异。我们试图研究冠心病患者住院管理的当代时间趋势。
通过使用“遵循指南-冠心病”注册研究的数据，我们比较了2003年至2008年间接受冠状动脉搭桥手术、经皮冠状动脉介入治疗或未接受干预的符合条件的冠心病患者对6项性能指标（24小时内使用阿司匹林、出院时使用阿司匹林、出院时使用β受体阻滞剂、射血分数低的患者出院时使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、戒烟咨询以及使用降脂药物）的依从性。
共有113971例冠心病患者在193家医院接受治疗。在所有3个治疗组中，随着时间的推移，对所有6项护理质量指标的总体依从性均有所提高，但在所有时间段内，经皮冠状动脉介入治疗组的依从性均高于冠状动脉搭桥手术组，而未接受干预组在所有时间点的预防措施使用率最低（P <.0001）。同样，在所有时间点，经皮冠状动脉介入治疗组对所有6项指标的100%依从性均更高（P <.0001）。在对患者病例组合进行多变量调整后，这些差异中的大多数仍然存在。
在过去十年中，无论血运重建策略如何，住院冠心病患者对二级预防措施的总体依从性都有显著提高。然而，仍有一些提高依从性的机会，特别是在接受冠状动脉搭桥手术或未接受干预的患者中。
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