Sharma Natasha, Khatib Rani, Elamin Nadir, Eaden James, Choong Chiat Ee, Jones Chris, Tayebjee Muzahir
Department of Cardiology, Leeds General Infirmary, Leeds, UK.
Eur J Hosp Pharm. 2016 Jul;23(4):203-206. doi: 10.1136/ejhpharm-2015-000783. Epub 2015 Nov 27.
Suboptimal dosing of angiotensin-converting enzyme inhibitors and β-blockers limits the mortality benefit for acute coronary syndrome patients. Recent National Institute for Health and Care Excellence (NICE) guidelines emphasise prompt initiation and up-titration from inpatient to community care to achieve this. The aim of this study was to assess the impact of simple interventions on inpatient and community up-titration of bisoprolol and ramipril for acute coronary syndrome patients admitted to Leeds General Infirmary.
An initial prospective audit of 37 acute coronary syndrome patients admitted to Leeds General Infirmary in January 2013 assessed inpatient up-titration of bisoprolol and ramipril, discharge advice and doses at 6 weeks after discharge. Following a collective multidisciplinary effort with education, posters and discharge advice templates, a re-audit of 34 acute coronary syndrome patients admitted from November to December 2014 assessed the impact of these interventions. The independent samples t test was used to compare the mean difference between doses of ramipril and bisoprolol from initiation to discharge to dose at 6 weeks after discharge before and after intervention.
There was a statistically significant improvement in the mean difference from initiation to discharge dose for both ramipril and bisoprolol (p=0.012 and p=0.017, respectively). However, there was little difference in community up-titration despite a 68% improvement in discharge advice.
Simple multidisciplinary interventions improved inpatient up-titration of ramipril and bisoprolol but continued up-titration to achieve the target doses remains a challenge in primary care. Acute coronary syndrome patients are precluded from maximum mortality benefit due to suboptimal dosing after discharge.
血管紧张素转换酶抑制剂和β受体阻滞剂的剂量未达最佳会限制急性冠脉综合征患者的死亡率获益。英国国家卫生与临床优化研究所（NICE）近期发布的指南强调要迅速开始用药，并从住院治疗逐步增加剂量至社区护理阶段，以实现这一目标。本研究旨在评估简单干预措施对利兹总医院收治的急性冠脉综合征患者在住院及社区护理阶段增加比索洛尔和雷米普利剂量的影响。
对2013年1月收治于利兹总医院的37例急性冠脉综合征患者进行初步前瞻性审计，评估比索洛尔和雷米普利的住院剂量增加情况、出院建议以及出院后6周的剂量。在开展了包括教育、张贴海报和出院建议模板在内的多学科共同努力后，对2014年11月至12月收治的34例急性冠脉综合征患者进行重新审计，评估这些干预措施的影响。采用独立样本t检验比较干预前后从开始用药到出院时的雷米普利和比索洛尔剂量与出院后6周剂量之间的平均差异。
雷米普利和比索洛尔从开始用药到出院时的平均剂量差异均有统计学显著改善（分别为p = 0.012和p = 0.017）。然而，尽管出院建议改善了68%，但社区护理阶段的剂量增加情况差异不大。
简单的多学科干预措施改善了雷米普利和比索洛尔在住院阶段的剂量增加情况，但在初级护理中持续增加剂量以达到目标剂量仍是一项挑战。由于出院后剂量未达最佳，急性冠脉综合征患者无法获得最大程度的死亡率获益。
