Butchard Michael, Kerr Andrew J, Grey Corina, Wu Billy, Hider Phil
Public Health Physician.
Cardiology Department, Middlemore Hospital; School of Population Health and Department of Medicine, University of Auckland.
N Z Med J. 2021 Mar 12;134(1531):36-54.
A number of evidence-based medications are recommended following an acute coronary syndrome (ACS), including statins, antithrombotics (antiplatelet and/or anticoagulants), a beta-blocker and an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACE-I/ARB). This study aimed to describe the dispensing of the cardioprotective medications in the first year following an ACS hospitalisation in New Zealand and how this varies according to age, sex and type of coronary intervention.
National hospitalisation data was used to identify all New Zealand residents aged 35-79 years who were discharged from hospital in the years 2013/14 with a primary discharge diagnosis of ACS. Using anonymous linkage to national pharmaceutical dispensing and mortality datasets, the dispensing of each group of medications was examined in survivors of quarters one, two and four of the first year post discharge.
There were 14,496 patients; mean age was 63.4 years and 68.8% were male. Dispensing of medications in survivors steadily fell across quarters one, two and four: 90.8%, 82.1% and 78.8% of patients were dispensed statins; 90.6%, 79.8% and 78.1% were dispensed aspirin; 82.7%, 72.6% and 70.0% were dispensed beta-blockers; 69.6%, 62.7% and 61.3% were dispensed ACE-I/ARB; 67.7%, 53.6% and 40.4% were dispensed a P2Y12 inhibitor; and 68.6%, 53.0% and 40.7% were dispensed a combination of two or more antithrombotics.
Cardioprotective medication dispensing was lower than would have been the case if the current ACS guidelines were followed. The greatest decrease in dispensing occurred between quarter one and quarter two, which highlights a potentially important period for targeted interventions to improve adherence.
急性冠状动脉综合征（ACS）后推荐使用多种循证药物，包括他汀类药物、抗栓药（抗血小板药和/或抗凝药）、β受体阻滞剂以及血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（ACE-I/ARB）。本研究旨在描述新西兰ACS住院治疗后第一年心脏保护药物的配药情况，以及其如何随年龄、性别和冠状动脉介入类型而变化。
利用全国住院数据识别出2013/14年度出院的、年龄在35 - 79岁之间、主要出院诊断为ACS的所有新西兰居民。通过与全国药品配药和死亡率数据集进行匿名关联，对出院后第一年第一、二和四季度的幸存者中每组药物的配药情况进行了检查。
共有14496例患者；平均年龄为63.4岁，68.8%为男性。第一、二和四季度幸存者的药物配药率稳步下降：服用他汀类药物的患者比例分别为90.8%、82.1%和78.8%；服用阿司匹林的比例分别为90.6%、79.8%和78.1%；服用β受体阻滞剂的比例分别为82.7%、72.6%和70.0%；服用ACE-I/ARB的比例分别为69.6%、62.7%和61.3%；服用P2Y12抑制剂的比例分别为67.7%、53.6%和40.4%；服用两种或更多抗栓药组合的比例分别为68.6%、53.0%和40.7%。
心脏保护药物的配药率低于遵循当前ACS指南时的情况。配药率下降最大的情况发生在第一季度和第二季度之间，这凸显了进行有针对性干预以提高依从性的一个潜在重要时期。
