Harder S, Thürmann P, Thierolf C, Klepzig H
Institute of Clinical Pharmacology, University Hospital, Frankfurt/Main, Germany.
Int J Clin Pharmacol Ther. 1998 Apr;36(4):195-201.
We evaluated ambulatory prescriptions by general practitioners for outpatients with cardiovascular (CV) disease referred to the cardiology outpatient clinic of the Frankfurt University Hospital in order to prove adherence to generally acknowledged therapy standards for treating CV disease.
Appropriateness of current CV medication was assessed according to the following criteria: aspirin or anticoagulants obligatory after myocardial infarction (MI), unless contraindicated; beta-blockers should be prescribed after MI, unless contraindicated or not tolerated; ACE inhibitors should be given in left ventricular dysfunction (LVD) after MI, unless contraindicated; and hypertension should be adequately controlled. 346 patients (28-94 years) received a median of 3 CV drug prescriptions (range 0-7). 240 patients had CAD, 142 patients previous MI, 121 patients had LVD (59 after MI), 143 patients were hypertensive. Aspirin was used appropriately in 80% of all MI patients, 13% received oral anticoagulants due to atrial fibrillation. However, 7% received no antithrombotic therapy. ACE inhibitors were administered in 65% of the MI patients with LVD. beta-blockers were used in 25% of the MI-patients. In the remaining patients, beta-blockers were contraindicated, not tolerated, and/or verapamil had been prescribed. However, in 14% of the patients beta-blockers were withheld without evident reason or alternative drug. In 41% of the hypertensive patients, blood pressure was not sufficiently controlled.
A considerable number of ambulatory prescriptions for CV drugs are not in accordance with current therapeutic guidelines. The role of a cardiology outpatient clinic to detect the misuse or underuse of CV drugs is emphasised.
我们评估了法兰克福大学医院心脏病门诊为心血管疾病（CV）门诊患者开具的门诊处方，以证明是否遵循公认的CV疾病治疗标准。
根据以下标准评估当前CV药物的合理性：心肌梗死（MI）后除非有禁忌，必须使用阿司匹林或抗凝剂；MI后除非有禁忌或不耐受，应开具β受体阻滞剂；MI后左心室功能不全（LVD）时应给予ACE抑制剂，除非有禁忌；高血压应得到充分控制。346例患者（28 - 94岁）平均接受3种CV药物处方（范围0 - 7种）。240例患者患有冠心病，142例患者有过MI，121例患者有LVD（MI后59例），143例患者患有高血压。所有MI患者中80%正确使用了阿司匹林，13%因房颤接受口服抗凝剂治疗。然而，7%未接受抗血栓治疗。LVD的MI患者中有65%使用了ACE抑制剂。MI患者中有25%使用了β受体阻滞剂。其余患者中，β受体阻滞剂有禁忌、不耐受和/或已开具维拉帕米。然而，14%的患者无明显原因或替代药物而未使用β受体阻滞剂。41%的高血压患者血压未得到充分控制。
相当数量的CV药物门诊处方不符合当前治疗指南。强调了心脏病门诊在检测CV药物滥用或使用不足方面的作用。
