Health Data Research Center, National Taiwan University, Taipei, Taiwan.
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
BMJ Open. 2023 Jul 19;13(7):e064219. doi: 10.1136/bmjopen-2022-064219.
To describe the occurrence of recurrent atherosclerotic cardiovascular disease (ASCVD) events within 3 years after a new-onset event, the associated disease burden and statin prescribing in patients with ASCVD in Taiwan.
Retrospective cohort study.
This was a retrospective cohort study using Taiwan's National Health Insurance Research Database.
In total, 111 399, 133 538 and 21 572 patients who were hospitalised with diagnosis of coronary heart disease (CHD), cerebrovascular disease (CBVD) and peripheral artery disease (PAD), respectively, between 1 January 2012 and 31 December 2014.
For each index and recurrent event, patients were observed for 12 months after admission to quantify risks of mortality, recurrent events, statin treatment and healthcare use.
We identified 97 321, 120 914 and 14 794 patients with new-onset CHD, CBVD and PAD, respectively. The proportions of developing first, second and third recurrent events were 22.5%, 25.6% and 30.9% for CHD; 20.9%, 26.2% and 32.4% for CBVD and 40.2%, 41.4% and 43.6% for PAD, respectively. Most patients had the same type of ASCVD for their recurrent events as their new-onset event. The mortality rates increased with each recurrent event (p<0.05 for all three ASCVD groups). The rates of hospital readmission and emergency room (ER) visit increased with increasing recurrent events. For example, in the CHD group, the 1-year readmission rates following the index, first and second recurrent events were 43.1%, 47.6% and 55.3%, respectively, and the proportions of visiting ER were 46.4%, 51.9% and 57.8%, respectively. Statin prescribing was suboptimal at time of index event and recurrent events.
Recurrent ASCVD events were associated with a higher risk of recurrent event and mortality and greater healthcare use. However, statin prescriptions at index event and after each recurrent event were suboptimal.
描述台湾地区新发动脉粥样硬化性心血管疾病（ASCVD）事件后 3 年内复发性 ASCVD 事件的发生情况、相关疾病负担以及 ASCVD 患者的他汀类药物处方情况。
回顾性队列研究。
本研究使用了台湾全民健康保险研究数据库进行回顾性队列研究。
2012 年 1 月 1 日至 2014 年 12 月 31 日期间，分别有 111399、133538 和 21572 名因冠心病（CHD）、脑血管疾病（CBVD）和外周动脉疾病（PAD）住院的患者纳入研究。
对于每个指标和复发性事件，患者在入院后随访 12 个月，以量化死亡率、复发性事件、他汀类药物治疗和医疗保健使用的风险。
我们分别确定了 97321、120914 和 14794 例新发 CHD、CBVD 和 PAD 患者。CHD 患者发生首次、第二次和第三次复发性事件的比例分别为 22.5%、25.6%和 30.9%；CBVD 患者的比例分别为 20.9%、26.2%和 32.4%；PAD 患者的比例分别为 40.2%、41.4%和 43.6%。大多数患者的复发性事件与新发事件为同一种 ASCVD。死亡率随复发性事件的增加而升高（三组 ASCVD 患者均为 p<0.05）。随着复发性事件的增加，住院再入院和急诊就诊的次数也增加。例如，在 CHD 组中，指数、首次和第二次复发性事件后 1 年的再入院率分别为 43.1%、47.6%和 55.3%，急诊就诊比例分别为 46.4%、51.9%和 57.8%。在指数事件和复发性事件时，他汀类药物的处方均不理想。
复发性 ASCVD 事件与更高的复发事件和死亡率风险以及更多的医疗保健使用相关。然而，在指数事件和每次复发性事件时，他汀类药物的处方均不理想。
