1 University of North Carolina Medical Center, Chapel Hill, NC, USA.
2 University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
Ann Pharmacother. 2018 Sep;52(9):868-875. doi: 10.1177/1060028018771061. Epub 2018 Apr 13.
In Wake County, NC, sudden unexpected death accounts for 10% to 15% of all natural deaths in individuals 18 to 64 years old. Medications such as aspirin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, and β-blockers are recommended in guidelines to reduce cardiovascular events and even sudden death (β-blockers). However, guidelines are often underpracticed, even in high-risk patients, with noted disparities in women.
We assessed the relation between prescription of evidence-based medications and sudden unexpected death in Wake County, NC.
We analyzed 399 cases of sudden unexpected death for the time period March 1, 2013 to February 28, 2015 in Wake County, NC. Medications were assessed from available medical examiner reports and medical records and grouped using the third level of the Anatomical Therapeutic Chemical Classification System (ATC) codes. This study was reviewed and exempt by the University of North Carolina's institutional review board.
Among 126 female and 273 male victims, women were prescribed more medications overall than men (6.5 vs 4.3, P = 0.001); however, the use of guideline-directed therapies was not different between genders in the chronic conditions associated with sudden death. Overall, there was remarkably low use of evidence-based medications.
Our findings highlight the need to improve prescribing of evidence-based medications and to further explore the relationship between undertreatment and sudden unexpected death.
在北卡罗来纳州威克县，18 至 64 岁人群中，10%至 15%的自然死亡由突发意外死亡导致。指南建议使用阿司匹林、血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、他汀类药物和β受体阻滞剂等药物来降低心血管事件甚至突发死亡（β受体阻滞剂）的风险。然而，即使在高危患者中，指南的实施情况也常常不佳，女性中尤为明显。
我们评估了北卡罗来纳州威克县开具循证药物与突发意外死亡之间的关系。
我们分析了北卡罗来纳州威克县 2013 年 3 月 1 日至 2015 年 2 月 28 日期间的 399 例突发意外死亡病例。从现有的法医报告和病历中评估药物，并使用解剖治疗化学分类系统（ATC）的第三级代码进行分组。本研究经北卡罗来纳大学机构审查委员会审查并豁免。
在 126 名女性和 273 名男性受害者中，女性总体上开具的药物多于男性（6.5 比 4.3，P=0.001）；然而，与突发死亡相关的慢性疾病中，男女之间指南指导的治疗方法的使用没有差异。总体而言，证据基础药物的使用率非常低。
我们的研究结果强调了需要改善循证药物的开具，并进一步探讨治疗不足与突发意外死亡之间的关系。
