法国 2009-2014 年冠心病住院负担：心肌梗死和/或经皮冠状动脉介入治疗的趋势。

Hospital burden of coronary artery disease: Trends of myocardial infarction and/or percutaneous coronary interventions in France 2009-2014.

机构信息

UPRES EA 2415, Clinical Research University Institute, Montpellier University, Montpellier, France.

LIRMM, UMR 5506, Montpellier University, Montpellier, France.

出版信息

PLoS One. 2019 May 2;14(5):e0215649. doi: 10.1371/journal.pone.0215649. eCollection 2019.

BACKGROUND

Currently, cardiovascular disease (CVD) is widely acknowledged to be the first leading cause of fatality in the world with 31% of all deaths worldwide and is predicted to remain as such in 2030. Furthermore, CVD is also a major cause of morbidity in adults worldwide. Among these diseases, the coronary artery disease (CAD) is the most common cause, accounting for over 40% of CVD deaths. Despite a decline in mortality rates, the consequences of more effective preventive and management programs, the burden of CAD remains significant. Indeed, the rise in the prevalence of modifiable risk factors due to changes in lifestyle and health behaviors has further increased the burden of this epidemic. Our objective was to evaluate the hospital burden of CAD via MI trends and Percutaneous Coronary Intervention (PCI) in the French Prospective Payment System (PPS).

METHODS

MI/PCI were identified in the national PPS database from 2009 to 2014 for patients aged 20 to 99, living in metropolitan France. We examined hospitalisation, readmission and mortality trends using standardised rates.

RESULTS

Over the six-year period, we identified 678,021 patients, representing 900,121 stays of which, 215,224 had a MI and a PCI. Admission trends increased by nearly 25%. Acute MI cases increased every year, with an alarming increase in women, and more specifically in young women. Men were 3 times more hospitalised than women, who were older. A North-South divide was noted. Twenty seven percent of patients experienced readmission within 1 month. Trajectories of care were significantly different by sex and age. Overall in-hospital death was 3.3%, decreasing by 15% during the period. The highest adjusted mortality rates were observed for inpatients aged <40 or >80.

CONCLUSION

We outlined the public health burden of this condition and the importance of improving the trajectories of care as an aid for better care.

背景

目前，心血管疾病（CVD）被广泛认为是全球第一大死亡原因，占全球所有死亡人数的 31%，预计到 2030 年仍将如此。此外，CVD 也是全球成年人发病率的主要原因。在这些疾病中，冠心病（CAD）最为常见，占 CVD 死亡人数的 40%以上。尽管死亡率有所下降，但由于生活方式和健康行为的改变导致可预防和管理的风险因素增加，CAD 的负担仍然很大。事实上，由于生活方式和健康行为的改变，可改变的风险因素的流行率上升，进一步增加了这种疾病的负担。我们的目的是通过法国前瞻性支付系统（PPS）中的 MI 趋势和经皮冠状动脉介入治疗（PCI）来评估 CAD 的医院负担。

方法

从 2009 年至 2014 年，我们在国家 PPS 数据库中为年龄在 20 至 99 岁之间、居住在法国大都市的患者识别 MI/PCI。我们使用标准化率检查住院、再入院和死亡率趋势。

结果

在六年期间，我们共确定了 678,021 名患者，共 900,121 人次住院，其中 215,224 人患有 MI 和 PCI。入院人数增加了近 25%。急性 MI 病例逐年增加，女性比例惊人增加，尤其是年轻女性。男性的住院人数是女性的 3 倍，而女性的年龄较大。还注意到南北之间的差异。27%的患者在 1 个月内再次入院。不同性别和年龄的治疗轨迹有显著差异。总的院内死亡率为 3.3%，在此期间下降了 15%。年龄<40 岁或>80 岁的住院患者的调整死亡率最高。