Respiratory Research Unit Zealand, Department of Respiratory Medicine, Naestved Hospital, Ringstedgade 61, 4700 Naestved, Denmark.
Department of Cardiology, Herlev and Gentofte University Hospital, Kildegaardsvej 2900, Hellerup, Denmark.
Eur Heart J Qual Care Clin Outcomes. 2020 Jan 1;6(1):23-31. doi: 10.1093/ehjqcco/qcy063.
To determine whether beta-blockers, aspirin, and statins are underutilized after first-time myocardial infarction (MI) in patients with chronic obstructive pulmonary disease (COPD) compared with patients without COPD. Further, to determine temporal trends and risk factors for non-use.
Using Danish nationwide registers, we performed a cross-sectional study investigating the utilization of beta-blockers, aspirin, and statins after hospitalization for first-time MI among patients with and without COPD from 1995 to 2015. Risk factors for non-use were examined in multivariable logistic regression models. During 21 years of study, 140 278 patients were included, hereof 13 496 (9.6%) with COPD. Patients with COPD were less likely to use beta-blockers (53.2% vs. 76.2%, P < 0.001), aspirin (73.9% vs. 78.8%, P < 0.001), and statins (53.5% vs. 61.9%, P < 0.001). Medication usage increased during the study period but in multivariable analyses, COPD remained a significant predictor for non-use: odds ratio (95% confidence interval) for non-use of beta-blockers 1.86 (1.76-1.97); aspirin 1.24 (1.16-1.32); statins 1.50 (1.41-1.59). Analyses stratified by ST-segment elevation myocardial infarction (STEMI) and non-STEMI showed similar undertreatment of COPD patients. Risk factors for non-use of beta-blockers in COPD included increasing age, female sex, and increasing severity of COPD (frequent exacerbations, use of multiple inhaled medications, and low lung function). Similar findings were demonstrated for aspirin and statins.
Beta-blockers, and to a lesser extent aspirin and statins, were systematically underutilized by patients with COPD following hospitalization for MI despite an overall increase in the utilization over time. Increasing severity of COPD was a risk factor for non-use of the medications.
确定与无慢性阻塞性肺疾病（COPD）的患者相比，β受体阻滞剂、阿司匹林和他汀类药物在 COPD 患者首次心肌梗死（MI）后是否未被充分利用。此外，确定不使用的时间趋势和危险因素。
使用丹麦全国登记处，我们进行了一项横断面研究，调查了 1995 年至 2015 年期间首次因 MI 住院的 COPD 和无 COPD 患者β受体阻滞剂、阿司匹林和他汀类药物的使用情况。使用多变量逻辑回归模型检查不使用的危险因素。在 21 年的研究期间，共纳入 140278 例患者，其中 13496 例（9.6%）患有 COPD。与无 COPD 的患者相比，COPD 患者使用β受体阻滞剂（53.2%比 76.2%，P<0.001）、阿司匹林（73.9%比 78.8%，P<0.001）和他汀类药物（53.5%比 61.9%，P<0.001）的可能性较小。在研究期间，药物使用量增加，但在多变量分析中，COPD 仍然是不使用的重要预测因素：β受体阻滞剂不使用的比值比（95%置信区间）为 1.86（1.76-1.97）；阿司匹林为 1.24（1.16-1.32）；他汀类药物为 1.50（1.41-1.59）。根据 ST 段抬高型心肌梗死（STEMI）和非 STEMI 进行分层分析显示，COPD 患者的治疗不足情况类似。COPD 患者β受体阻滞剂不使用的危险因素包括年龄增加、女性和 COPD 严重程度增加（频繁恶化、使用多种吸入药物和肺功能降低）。阿司匹林和他汀类药物也存在类似的发现。
尽管随着时间的推移，β受体阻滞剂、阿司匹林和他汀类药物的总体使用率有所增加，但 COPD 患者在 MI 住院后，β受体阻滞剂，在较小程度上还包括阿司匹林和他汀类药物，仍被系统地使用不足。COPD 严重程度增加是这些药物不使用的危险因素。
