Padilla López Ana, Alós-Almiñana Manuel, Peris José E
Servicio de Farmacia de Área, Departamento de Salud de Gandía, Gandía, Valencia, España.
Servicio de Farmacia, Hospital Clínico Universitario, Valencia, España.
Med Clin (Barc). 2020 Sep 25;155(6):242-248. doi: 10.1016/j.medcli.2019.11.008. Epub 2020 Jan 10.
Adequate medication intake affects treatment effectiveness. The aim of this study was to establish the impact of prescription and secondary adherence to beta-blockers on medium- and long-term and long-term cardiovascular outcomes, after a first type 1 ST-elevation myocardial infarction (STEMI) episode without heart failure or left ventricular ejection fraction ≥ 40%.
A retrospective observational study was conducted in a cohort of patients admitted from 2008 to 2013 to the University Clinical Hospital in Valencia. Competing risk analysis assessed the relationship between cardiovascular mortality or new vascular event with beta-blocker prescription and secondary adherence, defined as a proportion of days covered.
During after the first year following discharge, beta-blocker prescription was not significantly associated with better health outcomes in the 460 patients included. However, cardiovascular mortality was lower in adherent patients compared to non-adherent patients, at 0.6% vs. 6.6% (HR = 0.083; 95% CI, 0.015-0.448; p = 0.003), and in adherent patients compared to those who did not receive the treatment due to lack of prescription or lack of adherence, with 0.6% vs. 4.8% (HR = 0.115; 95% CI, 0.022-0.587; p = 0.009). These results were not observed when the complete follow-up period was analysed (median 46.7 months).
Secondary adherence to beta-blockers improves 1-year prognosis after STEMI with preserved left ventricular function.
充足的药物摄入会影响治疗效果。本研究的目的是确定在首次发生1型ST段抬高型心肌梗死（STEMI）且无心力衰竭或左心室射血分数≥40%的情况下，β受体阻滞剂的处方及二级依从性对中长期和长期心血管结局的影响。
对2008年至2013年入住巴伦西亚大学临床医院的一组患者进行了一项回顾性观察研究。竞争风险分析评估了心血管死亡率或新血管事件与β受体阻滞剂处方及二级依从性之间的关系，二级依从性定义为覆盖天数的比例。
在出院后的第一年，纳入的460例患者中，β受体阻滞剂处方与更好的健康结局无显著相关性。然而，依从性患者的心血管死亡率低于非依从性患者，分别为0.6%和6.6%（HR = 0.083；95%CI，0.015 - 0.448；p = 0.003），依从性患者与因未处方或未依从而未接受治疗的患者相比，分别为0.6%和4.8%（HR = 0.115；95%CI，0.022 - 0.587；p = 0.009）。在分析整个随访期（中位时间46.7个月）时未观察到这些结果。
β受体阻滞剂的二级依从性可改善左心室功能保留的STEMI患者1年的预后。
