社区居住老年男性的缺血性心脏病、最佳药物治疗处方与老年综合征：一项基于人群的研究。
Ischemic heart disease, prescription of optimal medical therapy and geriatric syndromes in community-dwelling older men: A population-based study.
作者信息
Gnjidic Danijela, Bennett Alexander, Le Couteur David G, Blyth Fiona M, Cumming Robert G, Waite Louise, Handelsman David, Naganathan Vasi, Matthews Slade, Hilmer Sarah N
机构信息
Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Ageing and Alzheimers Institute, Concord RG Hospital, Sydney, NSW, Australia.
Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia; Department of Clinical Pharmacology, Royal North Shore Hospital, Sydney, New South Wales, Australia; Department of Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia.
出版信息
Int J Cardiol. 2015 Aug 1;192:49-55. doi: 10.1016/j.ijcard.2015.05.045. Epub 2015 May 9.
BACKGROUND
Guideline recommended management of ischemic heart disease (IHD) suggests the concomitant use of antiplatelet, beta-blocker, renin angiotensin system blocker and statin therapy. In older people exposure to multiple medications has been associated with adverse events and geriatric syndromes. The study aimed to investigate the use of medications for IHD in older men with and without geriatric syndromes, and whether adherence to medication guidelines impacts on adverse outcomes.
METHODS
Community-dwelling men, aged ≥ 70 years and enrolled in the Concord Health and Ageing in Men Project were studied. Data on self-reported IHD, number of guideline recommended medications (use of four guideline medications considered optimal medical therapy) and geriatric syndromes (frailty, falls, cognitive impairment and urinary incontinence) were obtained. Cox regression was used to assess the relationship between optimal medical therapy and adverse outcomes (mortality and institutionalization), stratifying by geriatric syndromes.
RESULTS
At baseline, 462 (27%) men self-reported a history of IHD and of these, 226 (49%) had at least one geriatric syndrome. Among men with IHD, no significant difference was observed in patterns of prescribing between those with and without geriatric syndromes. Compared to zero medications, optimal medical therapy among men with IHD was associated with lower mortality [hazard ratio, HR = 0.40 (95% CI: 0.21-0.95)] and institutionalization risk (HR=0.31; 95% CI: 0.09-0.81). The presence of geriatric syndromes did not modify the association of increasing use of guideline recommended medications and clinical outcomes.
CONCLUSION
In older men with IHD, greater adherence to medication guidelines appears to be positively associated with better clinical outcomes, independent of geriatric syndromes.
背景
缺血性心脏病（IHD）的指南推荐管理建议联合使用抗血小板药物、β受体阻滞剂、肾素血管紧张素系统阻滞剂和他汀类药物治疗。在老年人中，同时服用多种药物与不良事件和老年综合征有关。本研究旨在调查有无老年综合征的老年男性IHD药物的使用情况，以及遵循药物指南是否会影响不良结局。
方法
对年龄≥70岁且参加了康科德男性健康与老龄化项目的社区男性进行研究。获取了关于自我报告的IHD、指南推荐药物数量（使用四种指南药物被认为是最佳药物治疗）和老年综合征（衰弱、跌倒、认知障碍和尿失禁）的数据。采用Cox回归评估最佳药物治疗与不良结局（死亡率和入住机构）之间的关系，并按老年综合征进行分层。
结果
在基线时，462名（27%）男性自我报告有IHD病史，其中226名（49%）至少有一种老年综合征。在患有IHD的男性中，有无老年综合征的患者在用药模式上未观察到显著差异。与未用药相比，患有IHD的男性采用最佳药物治疗与较低的死亡率[风险比，HR = 0.40（95%CI：0.21 - 0.95）]和入住机构风险（HR = 0.31；95%CI：0.09 - 0.81）相关。老年综合征的存在并未改变增加使用指南推荐药物与临床结局之间的关联。
结论
在患有IHD的老年男性中，更高程度地遵循药物指南似乎与更好的临床结局呈正相关，且不受老年综合征的影响。
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