Bobbio M, Imazio M, Tidu M, Presbitero P, Trinchero R, Brusca A
Division Universitaria di Cardiologia Ospedale Molinette, Torino.
G Ital Cardiol. 1997 Jun;27(6):549-56.
Despite growing interest concerning the prescription of different drugs in different clinical settings, no explanatory variables have been determined. The aim of this study was to verify if there are any differences in drug prescription at the time of hospital release following myocardial infarction and if any of these differences can be explained by scientific evidence concerning treatment efficacy.
All drugs prescribed to 430 patients discharged from three different cardiology departments after acute myocardial infarction were analyzed. Based on current scientific evidence, it has been, ascertained that aspirin, beta-blockers and ACE-inhibitors can be prescribed unless contraindicate whereas anticoagulants, nitrates and calcium antagonists should be prescribed only in specific clinical conditions. The odd ratio of prescription of each drug among the three cardiology departments was calculated and adjusted for any clinical and test result variables that can specifically affect drug prescription.
Different clinical characteristics of the patients discharged from the three cardiology departments are the following: mean age ranges from 60 to 66 years (p < 0.001), the incidence of non-Q myocardial infarction ranges from 23 to 45% (p < 0.001), post infarction angina ranges from 6 to 15% (p = 0.016), left ventricular failure ranges from 6 to 13% (p = 0.003) and arrhythmia ranges from 5 to 18% (p = 0.007). The adjusted odd ratio for clinical and test results variables showed that prescriptions were similar for ACE-inhibitors (odd ratio 1.3; 95% confidence interval from 0.6 to 3.2), aspirin (OR 2.2; 95% confidence interval from 0.8 to 5.5), beta-blockers (OR 2.2, 95% confidence interval from 0.9 to 5.5) and oral anticoagulants (1.6; 95% confidence interval from 0.6 to 4.5). Instead, there is a statistically significant difference in the prescription of nitrates (OR 4.4; 95% confidence interval from 1.6 to 12.3) and of calcium antagonists (OR 5.4%, 95% confidence interval from 1.0 to 12.5).
Evidence based drug efficacy after acute myocardial infarction seems to establish a uniform pattern of drug prescription in different cardiology departments.
尽管人们对不同临床环境下不同药物的处方越来越感兴趣，但尚未确定解释变量。本研究的目的是验证心肌梗死后出院时药物处方是否存在差异，以及这些差异是否可以用有关治疗效果的科学证据来解释。
分析了从三个不同心脏病科急性心肌梗死后出院的430例患者所开具的所有药物。根据当前的科学证据，已确定除非有禁忌，否则可以开具阿司匹林、β受体阻滞剂和血管紧张素转换酶抑制剂，而抗凝剂、硝酸盐和钙拮抗剂仅应在特定临床情况下开具。计算了三个心脏病科中每种药物处方的比值比，并针对任何可能具体影响药物处方的临床和检查结果变量进行了调整。
从三个心脏病科出院的患者的不同临床特征如下：平均年龄在60至66岁之间（p<0.001），非Q波心肌梗死的发生率在23%至45%之间（ p<0.001），梗死后心绞痛在6%至15%之间（p = 0.016），左心室衰竭在6%至13%之间（p = 0.003），心律失常在5%至18%之间（p = 0.007）。临床和检查结果变量的调整后比值比显示，血管紧张素转换酶抑制剂（比值比1.3；95%置信区间为0.6至3.2）、阿司匹林（比值比2.2；95%置信区间为0.8至5.5）、β受体阻滞剂（比值比2.2，95%置信区间为0.9至5.5）和口服抗凝剂（比值比1.6；95%置信区间为0.6至4.5）的处方相似。相反，硝酸盐（比值比4.4；95%置信区间为1.6至12.3）和钙拮抗剂（比值比5.4%，95%置信区间为1.0至12.5）的处方存在统计学上的显著差异。
急性心肌梗死后基于证据的药物疗效似乎在不同心脏病科建立了统一的药物处方模式。
