McDermott M M, Feinglass J, Lee P, Mehta S, Schmitt B, Lefevre F, Puppala J, Gheorghiade M
Department of Preventive Medicine, Northwestern University Medical School, Chicago, Ill 60611, USA.
Am Heart J. 1997 Nov;134(5 Pt 1):901-9. doi: 10.1016/s0002-8703(97)80013-0.
Since 1987, publications in widely circulated medical journals have reported improved survival and lower hospital readmission rates when patients with heart failure and systolic dysfunction are treated with angiotensin-converting enzyme (ACE) inhibitors. We describe changes in ACE inhibitor use among patients hospitalized with heart failure between 1986 and 1993. Simultaneous trends in readmissions and survival rates are reported. Subjects were 612 consecutive patients hospitalized with a principal diagnosis of heart failure at an academic medical center during the period of Sept. 1, 1986, to Dec. 31, 1987 (interval I) or during the period Aug. 1, 1992, to Nov. 30, 1993 (interval II). Medical records were reviewed for 434 patients, consisting of all patients hospitalized with heart failure during interval II and a randomly selected 50% subset of patients hospitalized during interval I. Among 145 patients with systolic dysfunction whose medical records were reviewed, ACE inhibitor prescriptions significantly increased between interval I and interval II (43% vs 71%, p < 0.01, odds ratio 3.22, 95% confidence interval 1.62 to 6.42). Prescriptions of ACE inhibitors combined with digoxin and a diuretic also increased (37% vs 56%, p = 0.02, odds ratio 2.22, 95% confidence interval 1.14 to 4.32). Among all 612 patients, 6-month heart failure readmission rates increased from 13% to 21% (p = 0.02, odds ratio 1.79, 95% confidence interval 1.10 to 2.82). There was no significant change in survival rate between interval I and interval II, however, survival rate was marginally significantly improved among patients with systolic dysfunction. Our results suggest that drug-prescribing practices have significantly changed between 1986 and 1993. The absence of observed improvement in outcomes may result from changes in hospital admission criteria for heart failure.
自1987年以来，在广泛发行的医学期刊上发表的文章报道称，当心力衰竭和收缩功能障碍患者接受血管紧张素转换酶（ACE）抑制剂治疗时，生存率得到提高，医院再入院率降低。我们描述了1986年至1993年间因心力衰竭住院患者中ACE抑制剂使用情况的变化。同时报告了再入院率和生存率的趋势。研究对象为1986年9月1日至1987年12月31日（时间段I）或1992年8月1日至1993年11月30日（时间段II）期间在一所学术医疗中心连续住院的612例主要诊断为心力衰竭的患者。对434例患者的病历进行了审查，其中包括时间段II期间所有因心力衰竭住院的患者以及从时间段I期间住院患者中随机抽取的50%的子集。在145例接受病历审查的收缩功能障碍患者中，ACE抑制剂处方在时间段I和时间段II之间显著增加（43%对71%，p<0.01，优势比3.22，95%置信区间1.62至6.42）。ACE抑制剂与地高辛和利尿剂联合使用的处方也增加了（37%对56%，p = 0.02，优势比2.22，95%置信区间1.14至4.32）。在所有612例患者中，6个月的心力衰竭再入院率从13%增加到21%（p = 0.02，优势比1.79，95%置信区间1.10至2.82）。时间段I和时间段II之间的生存率没有显著变化，然而，收缩功能障碍患者的生存率有轻微的显著改善。我们的结果表明，1986年至1993年间药物处方实践发生了显著变化。未观察到结局改善可能是由于心力衰竭住院标准的变化。
