Jánosi András, Ofner Péter, Kiss Zoltán, Kiss Levente, Kiss Róbert Gábor, Dinnyés József, Járai Zoltán, Nagy Gergely, Veress Gábor, Ferenci Tamás
Gottsegen György Országos Kardiológiai Intézet Budapest, Haller utca 29., 1096.
II. Belgyógyászati Klinika és Nefrológiai Központ, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs.
Orv Hetil. 2017 Jul;158(27):1051-1057. doi: 10.1556/650.2017.30795.
The aim was to study the patients' adherence to some evidence-based medication (statins, beta blockers, platelet and RAS inhibitors) after suffering a myocardial infarction, and its impact on the outcome.
Retrospective observational cohort study was carried out from the data of the Hungarian Myocardial Infarction Registry between January 1, 2013, and December 31, 2014. 14,843 patients were alive at the end of hospital treatment, from them, those who had no myocardial infarction or death until 180 days were followed for one year. The adherence was defined as the proportion of time from the index event to the endpoint (or censoring) covered with prescription fillings. The endpoint was defined as death or reinfarction. Information on filling prescriptions for statins, platelet aggregation inhibitors, beta blockers and ARB/ACEI-inhibitors were obtained. Multivariate regression was used to model adherence and survival time.
Good adherence (>80%) to clopidogrel, statins, beta blockers, aspirin and ARB/ACEI was found in 64.9%, 54.4%, 36.5%, 31.7% and 64.0%, respectively. Patients treated with PCI during the index hospitalization had higher adherence to all medication (all p<0.01), except for beta-blocker (p = 0.484). Multivariate analysis confirmed that adherence to statins, to clopidogrel and ARB/ACEI-inhibitors was associated with 10.1% (p<0.0001), 10.4% (p = 0.0002) and 15.8% (p<0.0001) lower hazard of endpoint respectively for 25% points increase in adherence, controlling for age, sex, performing of PCI, 5 anamnestic data and date of index event. Adherence to aspirin and beta blockers was not significantly associated with the hazard.
Higher adherence to some evidence-based medications was found to be associated with improved long term prognosis of the patients. Orv Hetil. 2017; 158(27): 1051-1057.
目的是研究心肌梗死后患者对某些循证药物（他汀类药物、β受体阻滞剂、血小板和肾素-血管紧张素系统抑制剂）的依从性及其对预后的影响。
利用匈牙利心肌梗死登记处2013年1月1日至2014年12月31日的数据进行回顾性观察队列研究。14843例患者在住院治疗结束时存活，其中在180天内无心肌梗死或死亡的患者被随访一年。依从性定义为从索引事件到终点（或删失）期间有处方配药覆盖的时间比例。终点定义为死亡或再梗死。获取了他汀类药物、血小板聚集抑制剂、β受体阻滞剂和ARB/ACEI抑制剂的配药信息。采用多变量回归对依从性和生存时间进行建模。
氯吡格雷、他汀类药物、β受体阻滞剂、阿司匹林和ARB/ACEI的良好依从性（>80%）分别见于64.9%、54.4%、36.5%、31.7%和64.0%的患者。在索引住院期间接受PCI治疗的患者对所有药物的依从性更高（所有p<0.01），β受体阻滞剂除外（p = 0.484）。多变量分析证实，依从性每增加25%，他汀类药物、氯吡格雷和ARB/ACEI抑制剂的依从性分别与终点风险降低10.1%（p<0.0001）、10.4%（p = 0.0002）和15.8%（p<0.0001）相关，同时控制年龄、性别、PCI操作、5项既往病史数据和索引事件日期。阿司匹林和β受体阻滞剂的依从性与风险无显著相关性。
发现对某些循证药物的更高依从性与患者更好的长期预后相关。《匈牙利医学周报》。2017年；158(27): 1051 - 1057。
