Annemans Lieven, Danchin Nicolas, Van de Werf Frans, Pocock Stuart, Licour Muriel, Medina Jesús, Bueno Héctor
Department of Public Health , I-CHER Interuniversity Centre for Health Economics Research , Ghent University , Ghent , Belgium.
Département de Cardiologie , Hôpital Européen Georges Pompidou & Université René Descartes , Paris , France.
Open Heart. 2016 Feb 24;3(1):e000347. doi: 10.1136/openhrt-2015-000347. eCollection 2016.
The aim of this report is to provide insight into real-world healthcare resource use (HCRU) during the critical management of patients surviving acute coronary syndromes (ACS), using data from EPICOR (long-tErm follow-up of antithrombotic management Patterns In acute CORonary syndrome patients) (NCT01171404).
EPICOR was a prospective, multinational, observational study that enrolled 10 568 ACS survivors from 555 hospitals in 20 countries in Europe and Latin America, between September 2010 and March 2011. HCRU was evaluated in patients with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation ACS (NSTE-ACS), with or without a history of cardiovascular disease (CVD). Multivariable analysis was performed to determine factors that affected resource use.
Before hospitalisation, more patients with STEMI than with NSTE-ACS had their first ECG (44.1% vs 36.4%, p<0.0001) and received antithrombotic medication (26.6% vs 15.2%, p<0.0001). Patients with NSTE-ACS with prior CVD were less likely than those without to be catheterised (73.1% vs 82.8%, p<0.0001). More patients with STEMI than with NSTE-ACS had percutaneous coronary intervention (77.1% vs 54.9%, p<0.0001), but fewer underwent coronary artery bypass grafting (1.2% vs 3.7%, p<0.0001). Multivariable analysis showed that resource use, including length of hospital stay and coronary revascularisation, was significantly influenced by multiple factors, including ACS type, site characteristics and region (all p≤0.05).
In this large-scale, real-life study, findings were generally in line with clinical logic, although site characteristics and region still significantly affected resource use. Moreover, and unexpectedly, resource use tended to be slightly higher in patients without a history of CVD.
NCT01171404 (ClinicalTrials.gov).
本报告旨在利用EPICOR（急性冠状动脉综合征患者抗血栓治疗模式的长期随访研究）（NCT01171404）的数据，深入了解急性冠状动脉综合征（ACS）存活患者在关键治疗阶段的实际医疗资源使用（HCRU）情况。
EPICOR是一项前瞻性、跨国、观察性研究，于2010年9月至2011年3月期间，纳入了来自欧洲和拉丁美洲20个国家555家医院的10568名ACS存活患者。对ST段抬高型心肌梗死（STEMI）或非ST段抬高型ACS（NSTE-ACS）患者，无论有无心血管疾病（CVD）病史，均进行医疗资源使用评估。进行多变量分析以确定影响资源使用的因素。
在住院前，STEMI患者比NSTE-ACS患者进行首次心电图检查的比例更高（44.1%对36.4%，p<0.0001），接受抗血栓药物治疗的比例也更高（26.6%对15.2%，p<0.0001）。有CVD病史的NSTE-ACS患者接受导管插入术的可能性低于无CVD病史的患者（73.1%对82.8%，p<0.0001）。STEMI患者接受经皮冠状动脉介入治疗的比例高于NSTE-ACS患者（77.1%对54.9%，p<0.0001），但接受冠状动脉旁路移植术的比例低于NSTE-ACS患者（1.2%对3.7%，p<0.0001）。多变量分析表明，包括住院时间和冠状动脉血运重建在内的资源使用受到多种因素的显著影响，包括ACS类型、医院特征和地区（所有p≤0.05）。
在这项大规模的现实生活研究中，研究结果总体上符合临床逻辑，尽管医院特征和地区仍对资源使用有显著影响。此外，出乎意料的是，无CVD病史患者的资源使用往往略高。
NCT01171404（ClinicalTrials.gov）。
