阿司匹林在冠心病二级预防中的应用现况

目的 了解中国多省市冠心病患者阿司匹林应用现况.方法 以2781例既往曾确诊患有冠心病的门诊患者为研究对象.2006年在中国内地31个省市自治区选择32家三级医院和32家二级医院,每家医院以研究启动时点起连续选择既往曾确诊冠心病的门诊患者50例.采用访谈形式收集患者信息,填写统一表格.主要分析患者阿司匹林的应用及医生处方情况.结果 (1)在2781例门诊冠心病患者中,男性1914例,女性867例,年龄(65±10)岁;(2)门诊冠心病患者阿司匹林的服用率为83.6%,男性(85.1%)高于女性(80.4%,P<0.01),随着年龄的增加,阿司匹林的服用率呈下降趋势(P<0.05),不同省市协作医院间阿司匹林的服用率存在差异(P<0.01),其中贵州省患者阿司匹林的服用率最低(64.2%),浙江省最高(97.8%);(3)门诊冠心病患者阿司匹林的处方率为90.4%,总计93.0%的医生处方剂量符合<阿司匹林在动脉硬化性心血管疾病中临床应用:中国专家共识(2005)>中建议使用的剂量(75～150 mg/d),不同省市协作医院医生处方剂量存在差异,个别医院1/3的处方剂量低于75 mg/d;(4)女性、高龄、月收入低、既往无经皮冠状动脉介入治疗史及冠心病病程长的门诊冠心病患者,阿司匹林的服用率低.结论 我国内地门诊冠心病患者阿司匹林的总服用率为83.6%,但31个省市、64家医院间差异较大;各医院医生阿司匹林处方剂量间也存在很大差异,应在冠心病二级预防中引起足够重视.

The present status of the use of aspirin for secondary prevention of coronary artery disease

Objective To examine the current status of the use of aspirin among outpatients with established coronary heart disease (CHD) in China. Methods Sixty-four hospitals across 31 provinces of China, including 32 secondary hospitals and 32 tertiary hospitals were selected for a baseline survey. Fifty outpatients with history of acute coronary syndrome (ACS) were recruited consecutively in each hospital.Information of these patients was collected and the situation of aspirin use among the patients was analyzed.Results There totally 2781 CHD outpatients were recruited with complete data. Mean age of the patients was 65±10. Sixty-nine percent of the patients was males and 31% was females. The utilization rate of aspirin before this clinical visit was 83.6%. There were significant difference among regions and hospitals.The utilization rate of aspirin was 64. 2% and 97. 8% respectively in the two provinces with the lowest use rate and the highest use rate. Use rates of aspirin in CHD outpatients varied from 29. 4% to 98% among 64 hospitals. The male CHD patients had higher use rate than the female patients did (85.1% vs. 80.4%, P<0.01). There also was notable difference in prescribed dose of aspirin among regions and hospitals. An analysis of multiple logistic regression model revealed that gender, age, monthly income, history of PCI and onset time of the previous ACS event were independently associated with the utilization status of aspirin in these outpatients. Conclusions The overall utilization rate of aspirin in CHD outpatients reached to 83.6%, but remarkable differences in aspirin use existed among regions, hospitals and patients with different characteristics in current clinical practice in China.