Marzaloni M, Bologna F, Pavesi P C, Galvani M, Violi E, Naccarella F, Santoro D, Di Pasquale G, Pantaleoni M, Lazzeroni E, Guiducci U
Presidio Ospedaliero, Rimini.
G Ital Cardiol. 1998 Oct;28(10):1072-82.
Recent Italian legislative directives have focused on lowering health-service costs and improving the quality of health care. The AI-CARE study on unstable angina represents the initial observational step in a survey on health-care quality in the Italian region Emilia-Romagna.
This study was performed to identify the processes usually involved in the management of patients with unstable angina admitted to a regional cardiology department. The consumption of health service resources and the clinical events related to angina were evaluated.
AI-CARE is an observational, descriptive and prospective study. Between 15/3/95 and 15/6/95, the patients admitted consecutively to 25 cardiology units for unstable angina, as diagnosed on a clinical basis, were enrolled in the study. A six-week follow-up was provided. The data regarding demographics, history, entry electrocardiogram, symptoms, examinations, treatment and outcome were recorded on a detailed personal questionnaire. The participating centers have been divided according to complexity of organization: 18 with intensive care unit as level I, five with hemodynamic laboratory as level II and two with cardiosurgery as level III. Mortality, myocardial infarction, revascularization procedures and readmissions for angina were considered clinical events.
We recruited 463 patients. At discharge, 411 patients were affected with unstable angina while other 40 developed non-Q wave infarctions. The final study population comprised 451 patients. The mean age was 68 years (range 61-76). There were 316 men (69%, mean age 68) and 135 women (mean age 72). All 451 patients were stratified according to the Braunwald classification: IIIB in 66.9%, IIIC in 9.9%, IB in 9.9%. Mean hospital stay was 10 +/- 6 days, while mean stay in intensive care units was 4.3 +/- 2.9 days. Medical treatment included antiplatelet agents (89%), nitrates i.v. (81%), nitrates per os (86%), heparin (55%) and beta-blockers (47%). The most common non-invasive test performed was echocardiogram (70% of patients), Holter ECG and exercise stress testing (19%). Selective coronary arteriography was performed in 50% of patients (23% during the first 10 days). Additionally, 32% of patients underwent revascularization. During follow-up, ten patients (2.21%) had a myocardial infarction, nine patients (1.99%) died and 49 patients (10.8%) were readmitted for angina.
This study indicates that in spite of the poor use of diagnostic procedures (especially coronary arteriography) and myocardial revascularization, mortality and morbidity were relatively low. Our data are similar to the results of the recent Italian EARISA study but differ greatly from the results of foreign studies. Consequently, further observation of our study population is needed.
意大利近期的立法指令着重于降低医疗服务成本并提高医疗质量。关于不稳定型心绞痛的AI-CARE研究是意大利艾米利亚-罗马涅地区医疗质量调查的初步观察阶段。
本研究旨在确定区域心脏病科收治的不稳定型心绞痛患者通常的管理流程。评估了医疗服务资源的消耗以及与心绞痛相关的临床事件。
AI-CARE是一项观察性、描述性和前瞻性研究。在1995年3月15日至1995年6月15日期间，连续入住25个心脏病科病房且临床诊断为不稳定型心绞痛的患者被纳入研究。进行了为期六周的随访。有关人口统计学、病史、入院心电图、症状、检查、治疗和结局的数据记录在一份详细的个人问卷上。参与研究的中心根据组织复杂性进行了划分：18个为一级有重症监护病房的中心，5个为二级有血流动力学实验室的中心，2个为三级有心脏外科的中心。死亡率、心肌梗死、血运重建手术以及因心绞痛再次入院被视为临床事件。
我们招募了463名患者。出院时，411名患者患有不稳定型心绞痛，另外40名发生了非Q波梗死。最终研究人群包括451名患者。平均年龄为68岁（范围61 - 76岁）。有316名男性（69%，平均年龄68岁）和135名女性（平均年龄72岁）。所有451名患者均根据Braunwald分类进行分层：IIIB级占66.9%，IIIC级占9.9%，IB级占9.9%。平均住院时间为10±6天，而在重症监护病房的平均停留时间为4.3±2.9天。药物治疗包括抗血小板药物（89%）、静脉注射硝酸盐类药物（81%）、口服硝酸盐类药物（86%）、肝素（55%）和β受体阻滞剂（47%）。最常进行的非侵入性检查是超声心动图（70%的患者）、动态心电图和运动负荷试验（19%）。50%的患者进行了选择性冠状动脉造影（23%在最初10天内进行）。此外，32%的患者接受了血运重建。在随访期间，10名患者（2.21%）发生了心肌梗死，9名患者（1.99%）死亡，49名患者（10.8%）因心绞痛再次入院。
本研究表明，尽管诊断程序（尤其是冠状动脉造影）和心肌血运重建的应用不足，但死亡率和发病率相对较低。我们的数据与意大利近期的EARISA研究结果相似，但与国外研究结果有很大差异。因此，需要对我们的研究人群进行进一步观察。
