稳定型急性心肌梗死后患者在农村与城市地区的长期预后比较：来自前瞻性、观察性 TIGRIS 注册研究的结果。
Long-term outcomes among stable post-acute myocardial infarction patients living in rural versus urban areas: insights from the prospective, observational TIGRIS registry.
机构信息
Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
London School of Hygiene and Tropical Medicine, London, UK.
出版信息
Open Heart. 2023 Aug;10(2). doi: 10.1136/openhrt-2023-002326.
BACKGROUND
Insights on the differences in clinical outcomes, quality of life (QoL) and health resource utilisation (HRU) with different levels of care available to post-acute myocardial infarction (AMI) populations in rural and urban settings are limited.
METHODS
The long-Term rIsk, clinical manaGement, and healthcare Resource utilisation of stable coronary artery dISease (TIGRIS), a prospective, observational registry, enrolled 8452 patients aged ≥50 years 1-3 years post-AMI from June 2013 to November 2014 from 24 countries in Asia Pacific/Australia, Europe, North America and South America. Differences in QoL (measured using the EuroQol Research Foundation instrument) and HRU between patients in rural and urban settings were evaluated in this post hoc analysis. The incidence of clinical endpoints (cardiovascular (CV) death, AMI, unstable angina with urgent revascularisation and stroke; bleeding; and all-cause mortality) was analysed. Data were collected at baseline and every 6 months for 24 months.
RESULTS
There were fewer hospitalisations and visits to general practitioners (GPs) and cardiologists in the rural versus urban populations (adjusted event rate ratio (ERR)=0.90 (95% CI, 0.82 to 1.00, p=0.04); ERR=0.84 (95% CI, 0.78 to 0.92, p<0.001); ERR=0.86 (95% CI, 0.81 to 0.92, p<0.001), respectively). No statistically significant differences were observed between rural and urban populations in all-cause death, AMI, unstable angina with urgent revascularisation, CV death, stroke, major bleeding events and health-related QoL. The adjusted incidence rate ratio was 0.92 (95% CI, 0.74 to 1.15) for the composite of CV death, AMI and stroke.
CONCLUSIONS
Living in rural areas was associated with fewer GP/cardiologist visits and hospitalisations; no significant differences in clinical outcomes and QoL were observed.
TRIAL REGISTRATION NUMBER
NCT01866904.
背景
在农村和城市环境中，患有急性心肌梗死（AMI）的患者可获得不同级别的治疗，而关于这些不同治疗水平下临床结局、生活质量（QoL）和卫生资源利用（HRU）的差异，目前了解有限。
方法
这项前瞻性观察性登记研究——长期风险、临床管理和稳定型冠状动脉疾病的医疗资源利用（TIGRIS），于 2013 年 6 月至 2014 年 11 月期间，在亚太/澳大利亚、欧洲、北美和南美 24 个国家招募了年龄≥50 岁、AMI 后 1-3 年的 8452 例患者，评估了农村和城市环境中患者的 QoL（使用欧洲生存质量五维量表进行评估）和 HRU 差异。对临床终点（心血管（CV）死亡、AMI、紧急血运重建的不稳定型心绞痛和卒中和出血；全因死亡率）的发生率进行了分析。数据在基线和 24 个月内每 6 个月采集一次。
结果
与城市人群相比，农村人群的住院和全科医生（GP）及心脏病专家就诊次数更少（校正事件发生率比（ERR）=0.90（95%CI，0.82 至 1.00，p=0.04）；ERR=0.84（95%CI，0.78 至 0.92，p<0.001）；ERR=0.86（95%CI，0.81 至 0.92，p<0.001））。农村和城市人群的全因死亡、AMI、紧急血运重建的不稳定型心绞痛、CV 死亡、卒中和主要出血事件以及健康相关 QoL 无统计学显著差异。CV 死亡、AMI 和卒中的复合终点的校正发病率比为 0.92（95%CI，0.74 至 1.15）。
结论
居住在农村地区与 GP/心脏病专家就诊和住院次数减少相关，但临床结局和 QoL 无显著差异。
临床试验注册
NCT01866904。
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