心肌梗死后患者的预防性护理。韦塞克斯研究网络（WReN）。

Preventive care for patients following myocardial infarction. The Wessex Research Network (WReN).

作者信息

Bradley F, Morgan S, Smith H, Mant D

机构信息

University of Southampton, Aldermoor Health Centre, UK.

出版信息

Fam Pract. 1997 Jun;14(3):220-6. doi: 10.1093/fampra/14.3.220.

DOI:10.1093/fampra/14.3.220

PMID:9201496

Abstract

OBJECTIVE

We aimed to assess general practice care for patients following a myocardial infarction (MI).

METHOD

A structured review was carried out of general practice records of patients identified from hospital administration data. A total of 266 survivors following MI were identified from the discharge data of 13 hospitals in Southern England and registered with 71 GPs belonging to the Wessex Research Network. Median time since hospital discharge was 2.1 years. The main outcome measures were the provision of appropriate preventive care, including cardiac rehabilitation, drug therapy, and lifestyle advice for modifiable risk factors.

RESULTS

Basic care was provided to nearly all patients; 253 (95.1%, 95% Cl 91.8-97.4) had blood pressure documented after their MI, 216 of 234 patients eligible for aspirin (92.3%; 88.1-95.4) had been recommended treatment, and the provision of advice on smoking cessation was documented for 27 of 33 continuing smokers (81.8%; 64.5-93.0). However, only 73 of 236 patients eligible to attend a structured rehabilitation programme (30.9%; 25.0-36.8) were documented as having received rehabilitation. Of 89 patients with heart failure following MI, 33 (37.1%; 27.1-48.0) had no record of having been offered treatment with an ACE inhibitor. Total cholesterol measurement was documented for only 144 patients (54.1%; 48.1-60.1). We estimate that there is still the potential to prevent between 4 and 9 deaths in this group of 266 surviving patients in the next 2 years by further improving the quality of follow-up care.

CONCLUSIONS

Preventive care in patients with proven ischaemic heart disease in general practice remains haphazard, even among doctors enthusiastic to participate in research and to audit their quality of care. As general practitioners we should ensure that we are providing high quality preventive care to patients with clinical disease before we focus on the even more demanding task of primary prevention.

摘要

目的

我们旨在评估心肌梗死（MI）患者的全科医疗护理情况。

方法

对从医院管理数据中识别出的患者的全科医疗记录进行了结构化回顾。从英格兰南部13家医院的出院数据中识别出总共266例心肌梗死后的幸存者，并在属于韦塞克斯研究网络的71名全科医生处登记。自出院后的中位时间为2.1年。主要结局指标是提供适当的预防性护理，包括心脏康复、药物治疗以及针对可改变的危险因素的生活方式建议。

结果

几乎所有患者都接受了基本护理；253例（95.1%，95%可信区间91.8 - 97.4）在心肌梗死后有血压记录，234例符合使用阿司匹林条件的患者中有216例（92.3%；88.1 - 95.4）被建议接受治疗，33例仍在吸烟的患者中有27例（81.8%；64.5 - 93.0）有戒烟建议的记录。然而，236例符合参加结构化康复计划条件的患者中只有73例（30.9%；25.0 - 36.8）有接受康复治疗的记录。在89例心肌梗死后发生心力衰竭的患者中，33例（37.1%；27.1 - 48.0）没有接受血管紧张素转换酶抑制剂治疗的记录。仅144例患者（54.1%；48.1 - 60.1）有总胆固醇测量记录。我们估计，通过进一步改善后续护理质量，在这266例存活患者组中，未来2年仍有可能预防4至9例死亡。