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一项关于外周动脉闭塞性疾病血运重建术后药物治疗的提供情况及结果的回顾性队列研究:研究方案

A retrospective cohort study on the provision and outcomes of pharmacological therapy after revascularisation for peripheral arterial occlusive disease: a study protocol.

作者信息

Peters Frederik, Kreutzburg Thea, Kuchenbecker Jenny, Debus Sebastian, Marschall Ursula, L'Hoest Helmut, Behrendt Christian-Alexander

机构信息

Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, GermanVasc, Hamburg, Germany.

BARMER, Wuppertal, Germany.

出版信息

BMJ Surg Interv Health Technol. 2020 Jan 27;2(1):e000020. doi: 10.1136/bmjsit-2019-000020. eCollection 2020.

DOI:10.1136/bmjsit-2019-000020
PMID:35047784
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8749289/
Abstract

BACKGROUND

Symptomatic peripheral arterial occlusive disease (PAOD) involves highly complex and costly revascularisations for preventing adverse limb events and impaired survival. Contrary to recommendations from valid guidelines, a large group of patients do not receive adequate pharmacological therapy after such interventions. Based on health insurance claims data, our study aims to assess (1) the extent of provision of pharmacological therapy after revascularisation and (2) related long-term outcomes for all patients and subgroups, that is, gender and disease severity.

METHODS

A retrospective observational population-based cohort study will be based on data from the second largest statutory health insurance fund in Germany (BARMER) covering about 13% of the insured population (~10 million patients). Study entry is the index revascularisation for symptomatic PAOD. Study variables will be analysed and compared among subgroups using parametric and non-parametric tests, generalised linear regression analysis and survival models.

DISCUSSION

This study will provide a comprehensive insight in the extent and time trends of adequate provision of pharmacological therapy and long-term outcomes for patients with symptomatic PAOD. This may help to identify those patients benefiting most from improved pharmacological therapy for increasing the success of revascularisations in general.

TRIAL REGISTRATION

NCT03909022.

摘要

背景

有症状的外周动脉闭塞性疾病(PAOD)涉及高度复杂且成本高昂的血管重建术,以预防肢体不良事件和生存受损。与有效指南的建议相反,一大批患者在这类干预后未接受充分的药物治疗。基于医疗保险理赔数据,我们的研究旨在评估:(1)血管重建术后药物治疗的提供程度;(2)所有患者及亚组(即性别和疾病严重程度)的相关长期结局。

方法

一项基于人群的回顾性观察队列研究将基于德国第二大法定医疗保险基金(BARMER)的数据,该基金覆盖约13%的参保人群(约1000万患者)。研究入组为有症状PAOD的首次血管重建术。研究变量将在亚组间使用参数和非参数检验、广义线性回归分析和生存模型进行分析和比较。

讨论

本研究将全面洞察有症状PAOD患者充分药物治疗的提供程度和时间趋势以及长期结局。这可能有助于识别那些从改善药物治疗中获益最大的患者,以总体上提高血管重建术的成功率。

试验注册

NCT03909022。

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本文引用的文献

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Editor's Choice - Comorbidity Patterns Among Patients with Peripheral Arterial Occlusive Disease in Germany: A Trend Analysis of Health Insurance Claims Data.编辑精选 - 德国外周动脉阻塞性疾病患者的合并症模式:基于健康保险索赔数据的趋势分析。
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2
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J Vasc Surg. 2019 Jun;69(6S):3S-125S.e40. doi: 10.1016/j.jvs.2019.02.016. Epub 2019 May 28.
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Global Vascular Guidelines for patients with critical limb-threatening ischemia.全球严重肢体缺血患者血管指南。
J Vasc Surg. 2019 Jun;69(6S):1S-2S. doi: 10.1016/j.jvs.2019.04.469. Epub 2019 May 28.
4
Worlds of Healthcare: A Healthcare System Typology of OECD Countries.世界医疗保健:经合组织国家的医疗保健系统分类。
Health Policy. 2019 Jul;123(7):611-620. doi: 10.1016/j.healthpol.2019.05.001. Epub 2019 May 11.
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Less Biased Estimation of the Survival Benefit of Carotid Endarterectomy Using Real-World Data: Bridging the Gap Between Observational Studies and Randomized Clinical Trials.利用真实世界数据对颈动脉内膜切除术生存获益进行偏差较小的估计:弥合观察性研究与随机临床试验之间的差距
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Editor's Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS).编辑推荐——2017年欧洲心脏病学会(ESC)与欧洲血管外科学会(ESVS)合作制定的外周动脉疾病诊断和治疗指南
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