Nguyen Thang, Nguyen Thao H, Pham Hoa T K, Nguyen Thu T A, Huynh Khoa M, Vo Phuong T B, Pham Tam T, Taxis Katja
Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.
Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands.
Trop Med Int Health. 2015 May;20(5):627-637. doi: 10.1111/tmi.12467. Epub 2015 Feb 16.
To determine the extent of physicians' adherence to prescribing guidelines for acute coronary syndrome in Vietnamese hospitals.
Retrospective cross-sectional study of medical records of all patients with ACS admitted to two public hospitals in Ho Chi Minh City, Vietnam, from January to December 2013. Percentages of eligible patients receiving guideline-recommended medications were determined. Factors associated with non-adherence were identified using multivariate logistic regression.
Overall, 711 medical records were reviewed and 284 patients fulfilled inclusion criteria (mean age 64 years; 69.4% male). Of those patients eligible for treatment, aspirin was prescribed for 97.9% at arrival and 96.3% at discharge; dual antiplatelet therapy was prescribed for 92.3% at arrival and 91.7% at discharge; loading doses were prescribed for 79.5% (aspirin) and 55.8% (clopidogrel); beta blockers were prescribed for 58.7% at arrival and 76.7% at discharge; angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) were prescribed for 89.1% at arrival or discharge; and statins were prescribed for 94.1% at arrival and 90.7% at discharge. Patients undergoing an invasive procedure were more likely to receive guideline-recommended medications at discharge: dual antiplatelet therapy (OR 3.77; 95% CI 1.23-11.52), beta blocker (OR 3.95; 95% CI 1.86-8.40) and ACEI/ARB (OR 4.01; 95% CI 1.30-12.41). Ninety of the excluded patients were discharged without completing treatment.
In general, physicians closely adhered to ACS prescribing guidelines in Vietnamese hospital practice. Prescribing of beta blockers and clopidogrel loading doses was probably suboptimal. Why patients do not complete treatment needs to be investigated.
确定越南医院医生对急性冠状动脉综合征处方指南的遵循程度。
对2013年1月至12月期间越南胡志明市两家公立医院收治的所有急性冠状动脉综合征患者的病历进行回顾性横断面研究。确定接受指南推荐药物治疗的符合条件患者的百分比。使用多因素逻辑回归确定与不遵循相关的因素。
总体而言，共审查了711份病历，284名患者符合纳入标准（平均年龄64岁；男性占69.4%）。在那些符合治疗条件的患者中，阿司匹林在入院时的处方率为97.9%，出院时为96.3%；双联抗血小板治疗在入院时的处方率为92.3%，出院时为91.7%；负荷剂量的处方率分别为79.5%（阿司匹林）和55.8%（氯吡格雷）；β受体阻滞剂在入院时的处方率为58.7%，出院时为76.7%；血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（ACEI/ARB）在入院或出院时的处方率为89.1%；他汀类药物在入院时的处方率为94.1%，出院时为90.7%。接受侵入性手术的患者在出院时更有可能接受指南推荐的药物治疗：双联抗血小板治疗（比值比3.77；95%置信区间1.23 - 11.52）、β受体阻滞剂（比值比3.95；95%置信区间1.86 - 8.40）和ACEI/ARB（比值比4.01；95%置信区间1.30 - 12.41）。90名被排除的患者未完成治疗就出院了。
总体而言，在越南医院的实际医疗中，医生密切遵循急性冠状动脉综合征的处方指南。β受体阻滞剂和氯吡格雷负荷剂量的处方可能未达最佳。需要调查患者未完成治疗的原因。
