芬兰疗养院和辅助生活设施中预防中风和冠心病的处方变化。
Change in Prescribing for Secondary Prevention of Stroke and Coronary Heart Disease in Finnish Nursing Homes and Assisted Living Facilities.
机构信息
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
Pharmacy Department, Alfred Hospital, Melbourne, Australia.
出版信息
Drugs Aging. 2019 Jun;36(6):571-579. doi: 10.1007/s40266-019-00656-x.
BACKGROUND
One quarter of residents in long-term care facilities (LTCFs) have a diagnosis of CHD or stroke and over half use at least one preventative cardiovascular medication. There have been no studies that have investigated the longitudinal change in secondary preventative cardiovascular medication use in residents in LTCFs over time.
OBJECTIVE
The aim of this study was to investigate the change in cardiovascular medication use among residents with coronary heart disease (CHD) and prior stroke in nursing homes (NHs) and assisted living facilities (ALFs) in Finland over time, and whether this change differs according to dementia status.
METHODS
Three comparable cross-sectional audits of cardiovascular medication use among residents aged 65 years and over with CHD or prior stroke in NHs in 2003 and 2011 and ALFs in 2007 and 2011 were compared. Logistic regression analyses adjusted for gender, age, mobility, cancer and length of stay were performed to examine the effect of study year, dementia and their interaction on medication use.
RESULTS
Cardiovascular medication use among residents with CHD (NHs: 89% vs 70%; ALFs: 89% vs 84%) and antithrombotic medication use among residents with stroke (NHs: 72% vs 63%; ALFs: 78% vs 69%) declined between 2003 and 2011 in NHs and 2007 and 2011 in ALFs. Decline in the use of diuretics, nitrates and digoxin were found in both groups and settings. Cardiovascular medication use among residents with CHD and dementia declined in NHs (88% [95% CI 85-91] in 2003 vs 70% [95% CI 64-75] in 2011) whereas there was no change among people without dementia. There was no change in cardiovascular medication use among residents with CHD in ALFs with or without dementia over time. Antithrombotic use was lower in residents with dementia compared with residents without dementia in NHs (p < 0.001) and ALFs (p = 0.026); however, the interaction between dementia diagnosis and time was non-significant.
CONCLUSIONS
The decline in cardiovascular medication use in residents with CHD and dementia suggests Finnish physicians are adopting a more conservative approach to the management of cardiovascular disease in the NH population.
背景
四分之一的长期护理机构（LTCF）居民被诊断患有 CHD 或中风，超过一半的人至少使用一种预防心血管药物。目前还没有研究调查 LTCF 居民随着时间的推移，预防心血管药物使用的纵向变化。
目的
本研究旨在调查芬兰养老院（NH）和辅助生活设施（ALF）中患有冠心病（CHD）和既往中风的居民心血管药物使用的变化情况，并探讨其是否因痴呆状态而有所不同。
方法
对 2003 年、2011 年 NH 和 2007 年、2011 年 ALF 中年龄在 65 岁及以上患有 CHD 或既往中风的居民进行了三次心血管药物使用的横断面比较审计。对性别、年龄、活动能力、癌症和住院时间进行了调整，采用逻辑回归分析，以评估研究年份、痴呆和两者之间的交互作用对药物使用的影响。
结果
NH 中患有 CHD 的居民（89% vs 70%）和患有中风的居民（NH：89% vs 78%；ALF：89% vs 84%）的心血管药物使用率以及中风患者的抗血栓药物使用率（NH：72% vs 63%；ALF：78% vs 69%）均从 2003 年至 2011 年在 NH 和 2007 年至 2011 年在 ALF 中呈下降趋势。两组和两种环境中均发现利尿剂、硝酸盐和地高辛的使用减少。NH 中患有 CHD 和痴呆的居民的心血管药物使用率从 2003 年的 88%（95%CI 85-91）降至 2011 年的 70%（95%CI 64-75），而无痴呆患者的使用率则无变化。患有 CHD 且无痴呆的居民在 ALF 中，无论是否患有痴呆，心血管药物的使用在不同时间点均无变化。患有痴呆的居民抗血栓药物使用率低于无痴呆的居民（NH：p<0.001；ALF：p=0.026）；然而，痴呆诊断与时间之间的交互作用无统计学意义。
结论
患有 CHD 和痴呆的居民心血管药物使用率下降表明，芬兰医生在 NH 人群中对心血管疾病的管理采取了更为保守的方法。
Zotero 插件