Martínez M, Agustí A, Arnau J M, Vidal X, Laporte J R
Institut Català de Farmacologia, CSU Vall d'Hebron, Department of Pharmacology and Therapeutics, Universitat Autònoma de Barcelona, Spain.
Eur J Clin Pharmacol. 1998 May;54(3):203-8. doi: 10.1007/s002280050446.
The efficacy of beta-adrenergic blocking agents and acetylsalicylic acid in the secondary prevention of myocardial infarction has been well recognized since the beginning of the 1980s. In a previous paper, however, we reported a lower than expected use of these drugs during the period 1982 1988. In 1989 the results of this survey were presented and discussed with the prescribing physicians. In the present paper we describe the prescription patterns for the same indication and in the same centre over the following 6 years (1989-1994). We also describe the use of angiotensin-converting enzyme (ACE) inhibitors, for which efficacy in certain subgroups has been recently shown.
Random samples of patients discharged from our hospital between 1989 and 1994 with a diagnosis of acute myocardial infarction with Q-wave were studied. Information about diagnoses, other clinical variables and treatments prescribed at discharge was obtained from the hospital discharge forms. The results were compared with those obtained in the previous study.
We studied 514 patients (80% men) with a median age of 59 years (range 31-89). The proportions of patients prescribed beta-adrenergic blocking agents and acetylsalicylic acid increased from 34% and 28%, respectively, in 1986-1988, to 62% and 75% in 1989 1991. In 1994 they had reached a steady state (63% and 71%). In addition, a continued decrease in the use of calcium channel blockers was noted, from 36% in 1986-1988 to 17% in 1994. The increase in the prescription of beta-adrenergic blocking agents was especially remarkable in the subgroups for which a larger underuse was recorded in the previous study, such as the elderly. The proportion of patients prescribed an ACE inhibitor increased from 14% in 1989-1991 to 23% in 1994. In a multivariate analysis the prescription of ACE inhibitors was associated with female gender, hypertension during admission, heart failure during admission, and previous myocardial infarction. A substantial increase in the prescription of beta-adrenergic blocking agents and acetylsalicylic acid and a decrease in the prescription of calcium channel blockers was recorded between 1982 and 1994. The prescription rate of beta-adrenergic blocking agents has increased substantially in certain subgroups where underuse had been previously recorded. Most of the changes occurred in 1989-1991, and reached a steady state in 1994. In 1994 an increase in the prescription of ACE inhibitors was also recorded.
自20世纪80年代初以来，β-肾上腺素能阻滞剂和乙酰水杨酸在心肌梗死二级预防中的疗效已得到充分认可。然而，在之前的一篇论文中，我们报道了1982年至1988年期间这些药物的使用低于预期。1989年，我们公布了这项调查的结果，并与开处方的医生进行了讨论。在本文中，我们描述了接下来6年（1989 - 1994年）同一中心针对相同适应症的处方模式。我们还描述了血管紧张素转换酶（ACE）抑制剂的使用情况，最近已证明其在某些亚组中具有疗效。
研究了1989年至1994年期间从我院出院、诊断为Q波型急性心肌梗死的患者随机样本。从医院出院表格中获取有关诊断、其他临床变量及出院时所开治疗的信息。将结果与之前研究所得结果进行比较。
我们研究了514例患者（80%为男性），中位年龄为59岁（范围31 - 89岁）。开具β-肾上腺素能阻滞剂和乙酰水杨酸的患者比例分别从1986 - 1988年的34%和28%，增至1989 - 1991年的62%和75%。1994年达到稳定状态（63%和71%）。此外，注意到钙通道阻滞剂的使用持续减少，从1986 - 1988年的36%降至1994年的17%。β-肾上腺素能阻滞剂处方的增加在之前研究中使用不足情况较为严重的亚组中尤为显著，如老年人。开具ACE抑制剂的患者比例从1989 - 1991年的14%增至1994年的23%。在多变量分析中，ACE抑制剂的处方与女性性别、入院时高血压、入院时心力衰竭及既往心肌梗死相关。1982年至1994年期间，β-肾上腺素能阻滞剂和乙酰水杨酸的处方大幅增加，钙通道阻滞剂的处方减少。β-肾上腺素能阻滞剂的处方率在之前记录有使用不足情况的某些亚组中大幅增加。大多数变化发生在1989 - 1991年，并于1994年达到稳定状态。1994年还记录到ACE抑制剂的处方增加。
