描述性分析香港和美国急性冠脉综合征患者他汀类药物和抗血小板药物的真实世界用药模式。
Descriptive analysis of real-world medication use pattern of statins and antiplatelet agents among patients with acute coronary syndrome in Hong Kong and the USA.
机构信息
Peninsula Clinical School, Monash University, Clayton, Victoria, Australia.
University of Southern California Sol Price School of Public Policy, Los Angeles, California, USA.
出版信息
BMJ Open. 2019 Jul 16;9(7):e024937. doi: 10.1136/bmjopen-2018-024937.
OBJECTIVES
The objective was to explore the differences in medication use pattern of lipid-lowering drug (LLD) and antiplatelet agents among post-percutaneous coronary intervention patients with acute coronary syndrome aged <65 in Hong Kong (HK) and the USA.
DESIGN
Retrospective study.
SETTING
This study used deidentified claims data from Clinformatics Data Mart database (OptumInsight, Eden Prairie, Minnesota, USA) and electronic health records from HK Hospital Authority Clinical Data Analysis and Reporting System database.
PARTICIPANTS
We used 1 year prescription records of LLDs and antiplatelet agents among 1013 USA patients and 270 HK Chinese patients in 2011-2013.
PRIMARY AND SECONDARY OUTCOME MEASURES
Continuity was investigated on the assumption that one defined daily dose represented 1 day treatment. Medication possession ratio method was used to evaluate the adherence. Multivariate-adjusted logistic regressions were constructed to compare the good continuity and adherence levels in the merged database with the cutoffs set at 80%, and Cox proportional hazard models were built using the time to discontinuation as the dependent variable, to assess the persistence level.
RESULTS
HK Chinese patients were less adherent (67.41% vs 84.60%, adjusted odds ratio (AOR) for Americans over Chinese=2.23 (95% CI=1.60 to 3.12), p<0.001) to antiplatelet agents compared with American patients but better adherent to statins (90.00% vs 78.18%, AOR=0.37 (0.23 to 0.58), p<0.001). The discontinuation with statins was more common in American patients (13.33% vs 34.25%, adjusted hazard ratio (AHR)=2.95 (2.05 to 4.24), p<0.001). Low-to-moderate potency statins and clopidogrel were favoured by our HK local physicians, while American patients received higher doses of statins and prasugrel.
CONCLUSIONS
We seemed to find HK physicians tended to prescribe cheaper and lower doses of statins and antiplatelet agents when compared with the privately insured patients in the USA, though the adherence and persistence levels of HK patients with statins were relatively good.
目的
本研究旨在探讨香港（HK）和美国年龄<65 岁的急性冠脉综合征行经皮冠状动脉介入治疗（PCI）的患者在降脂药（LLD）和抗血小板药物的使用模式方面的差异。
设计
回顾性研究。
设置
本研究使用了来自 OptumInsight（明尼苏达州伊登草原）Clinformatics Data Mart 数据库的匿名索赔数据和 HK 医院管理局临床数据分析和报告系统数据库的电子健康记录。
参与者
我们使用了 2011-2013 年 1013 名美国患者和 270 名 HK 中国患者的 LLD 和抗血小板药物 1 年处方记录。
主要和次要结果
假设一个定义的日剂量代表 1 天的治疗，我们对连续性进行了研究。药物使用比例法用于评估依从性。采用多变量调整的逻辑回归比较合并数据库中 80%的截断值下的良好连续性和依从性水平，并使用停药时间作为因变量构建 Cox 比例风险模型，以评估持久性水平。
结果
与美国患者相比，HK 中国患者对抗血小板药物的依从性较差（67.41% vs 84.60%，美国人相对于中国人的调整优势比（AOR）=2.23（95%CI=1.60 至 3.12），p<0.001），但对他汀类药物的依从性较好（90.00% vs 78.18%，AOR=0.37（0.23 至 0.58），p<0.001）。美国患者使用他汀类药物的停药更为常见（13.33% vs 34.25%，调整后的风险比（AHR）=2.95（2.05 至 4.24），p<0.001）。我们的 HK 当地医生倾向于开处方使用价格较低和剂量较低的他汀类药物和抗血小板药物，而美国患者则接受了更高剂量的他汀类药物和普拉格雷。
结论
与美国私人保险患者相比，我们发现 HK 医生在开处方时似乎更倾向于使用价格较低和剂量较低的他汀类药物和抗血小板药物，尽管 HK 患者使用他汀类药物的依从性和持久性相对较好。
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