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缩小美国成年人中冠心病患者二级预防用药方面的差距。

Closing gaps in medication taking for secondary prevention of coronary heart disease patients among US adults.

作者信息

Liu Xiaowei, Tang Lijiang, Tang Ying, Du Changqing, Chen Xiaofeng, Xu Cheng, Yan Jing

机构信息

The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, PR China.

Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, PR China.

出版信息

Heliyon. 2022 Nov 11;8(11):e11530. doi: 10.1016/j.heliyon.2022.e11530. eCollection 2022 Nov.

Abstract

BACKGROUND

The secondary preventive medical remedies used in the U.S. general population, particularly those with numerous co-morbidities, are poorly understood. We aimed to assess health outcomes and the extent of their adherence to guideline-based secondary prevention medications among U.S. coronary heart disease (CHD) patients.

METHODS

We analysed information from the U.S. National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 on people in the United States aged 18 to 85 who had a personal history of coronary heart disease (CHD). Logistic regression analyses were used to identify characteristics related to healthcare access that were linked with not taking any indicated drugs among CHD and other co-morbidity patients in the U.S.

RESULTS

We gathered 4256 CHD patients aged 18 and above. Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), statins, and antiplatelet medications were taken by 50.94%, 48.26%, 53.41 %, and 19.78% of the population, respectively. Surprising, not received recommended drugs was reached up to 21.12%, and taking all four drugs was only 7.64%. In conclusion, the logistic regression analysis revealed that the chance of not taking prescribed drugs increased with age (18-39), race (Hispanic and Non-Hispanic Black), low income, lack of insurance, and the absence of co-morbidities (hypertension, heart failure, and diabetes mellitus).

CONCLUSIONS

The gap between the proposed secondary preventative measures and their actual execution remains sizable. In order to achieve 'Healthy Aging', a systematic approach for prevention of CHD is urgently needed.

摘要

背景

美国普通人群,尤其是患有多种合并症的人群,对二级预防药物疗法了解甚少。我们旨在评估美国冠心病(CHD)患者的健康状况以及他们对基于指南的二级预防药物的依从程度。

方法

我们分析了1999年至2018年美国国家健康与营养检查调查(NHANES)中关于18至85岁有冠心病个人病史的美国人的信息。采用逻辑回归分析来确定与医疗保健可及性相关的特征,这些特征与美国冠心病及其他合并症患者未服用任何指定药物有关。

结果

我们收集了4256名18岁及以上的冠心病患者。分别有50.94%、48.26%、53.41%和19.78%的人群服用了血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂(ACEIs/ARBs)、他汀类药物、抗血小板药物。令人惊讶的是,未接受推荐药物的比例高达21.12%,而同时服用所有四种药物的仅占7.64%。总之,逻辑回归分析显示,未按规定服药的几率随着年龄(18 - 39岁)、种族(西班牙裔和非西班牙裔黑人)、低收入、缺乏保险以及没有合并症(高血压、心力衰竭和糖尿病)而增加。

结论

建议的二级预防措施与其实际执行之间的差距仍然很大。为了实现“健康老龄化”,迫切需要一种系统的冠心病预防方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/899a/9667245/313cd76e1608/gr1.jpg

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