在荷兰的一个国家数据库中，对一般实践中老年患者的降脂药物处方模式进行分析。

Prescription patterns of lipid lowering agents among older patients in general practice: an analysis from a national database in the Netherlands.

机构信息

Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.

NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.

出版信息

Age Ageing. 2019 Jul 1;48(4):577-582. doi: 10.1093/ageing/afz034.

DOI:10.1093/ageing/afz034

PMID:31074492

Abstract

BACKGROUND

Dutch cardiovascular risk management guidelines state almost every older adult (≥70 years) is eligible for a lipid lowering drug (LLD). However, life expectancy, frailty or comorbidities may influence this treatment decision.

OBJECTIVE

investigate how many older adults, according to age, frailty (Drubbel-frailty index) and comorbidities were prescribed LLDs.

METHODS

data of 244,328 adults ≥70 years from electronic health records of 415 Dutch general practices from 2011-15 were used. Number of LLD prescriptions in patients with (n = 55,309) and without (n = 189,019) cardiovascular disease (CVD) was evaluated according to age, frailty and comorbidities.

RESULTS

about 69% of adults ≥70 years with CVD and 36% without CVD were prescribed a LLD. LLD prescriptions decreased with age; with CVD: 78% aged 70-74 years and 29% aged ≥90 years were prescribed a LLD, without CVD: 37% aged 70-74 years and 12% aged ≥90 years. In patients with CVD and within each age group, percentage of LLD prescriptions was 20% point(pp) higher in frail compared with non-frail. In patients without CVD, percentage of LLD prescriptions in frail patients was 11pp higher in adults aged 70-74 years and 40pp higher in adults aged ≥90 years compared to non-frail. Similar trends were seen in the analyses with number of comorbidities.

CONCLUSION

in an older population, LLD prescriptions decreased with age but-contrary to our expectations-LLD prescriptions increased with higher frailty levels.

摘要

背景

荷兰心血管风险管理指南指出，几乎每个老年人（≥70 岁）都有资格使用降脂药物（LLD）。然而，预期寿命、虚弱或合并症可能会影响这一治疗决策。

目的

根据年龄、虚弱程度（Drubbel 虚弱指数）和合并症，调查有多少老年人被开处方使用 LLD。

方法

使用来自 2011 年至 2015 年间 415 家荷兰普通诊所的电子健康记录中的 244328 名≥70 岁成年人的数据。根据年龄、虚弱和合并症评估患有（n=55309）和不患有（n=189019）心血管疾病（CVD）的患者的 LLD 处方数量。

结果

大约 69%患有 CVD 的≥70 岁成年人和 36%没有 CVD 的成年人被开处方使用 LLD。LLD 处方随着年龄的增长而减少；患有 CVD：78%年龄在 70-74 岁之间，29%年龄在≥90 岁之间被开处方使用 LLD，没有 CVD：37%年龄在 70-74 岁之间，12%年龄在≥90 岁之间。在患有 CVD 的患者中，在每个年龄组内，与非虚弱患者相比，虚弱患者的 LLD 处方比例高 20 个百分点（pp）。在没有 CVD 的患者中，与非虚弱患者相比，70-74 岁年龄组的虚弱患者的 LLD 处方比例高 11pp，≥90 岁年龄组的虚弱患者的 LLD 处方比例高 40pp。在分析合并症数量时也出现了类似的趋势。