老年急性心肌梗死患者出院后二级预防药物应用现状调查

目的调查老年急性ST段抬高型心肌梗死(STEMI)患者出院后二级预防药物应用现状,分析影响二级预防药物应用的因素。方法回顾性分析2008年8月至2010年7月在北京市通州区潞河医院CCU连续住院治疗并好转出院的老年STEMI患者180例,其中男性113例,女性67例,2010年11月至2011年1月通过门诊或电话随访,随访时间为6～24个月,平均随访时间为(12.2±5.1)个月,分析老年STEMI患者出院后二级预防药物应用的状况及其影响因素。结果与住院时相比,随访时各种药物应用率均明显下降,阿司匹林(91.7%比98.3%),氯吡格雷(90.6比100%),β受体阻滞剂(66.7%比78.3%),ACEI/ARB(58.9%比77.2%),他汀类药物(81.1%比95.6%),均为P<0.05。影响老年STEMI患者出院后二级预防药物应用的主要因素是患者依从性差及医生未按指南进行处方。结论老年STEMI患者出院后二级预防药物应用与指南存在差距,ACEI/ARB、β受体阻滞剂应用率偏低;患者用药依从性差和医生未能按指南进行处方是影响老年STEMI患者出院后药物应用的主要因素。

Situation of secondary prevention medications application in elderly patients with acute myocardial infarction

Objective To investigate the situation and influencing factors of the secondary prevention medications application after discharge in elderly patients with acute ST-segment elevation myocardial infarction(STEMI). Methods In this retrospective study,a total of 180 elderly survivors(113 male,67 female) with STEMI were enrolled from August 2008 to July 2010 in Luhe Hospital.All the patients were followed up in clinic or by telephone from November 2010 to January 2011.The average follow-up period was 12.2 ± 5.1(6-24)months.The influencing factors on the secondary prevention medications application were analyzed. Results Compared with the medication taken in hospital,a significant decline was observed in the use of aspirin(91.7% vs.98.3%),clopidogrel(90.6% vs.100%),β-blockers(66.7%vs.78.3%),ACEI/ARB(58.9% vs.77.2%) and lipid-lowering drugs(81.1% vs.95.6%)(all P<0.05) during the period of following up.The main influencing factors on medication application after discharge were the patients′ poor compliance and doctors failing to prescribe in accordance with the guidelines. Conclusions There is a wide gap between guidelines and real world medication application for secondary prevention in elderly patients with STEMI after discharge.Especially the application rates of ACEI/ARB and β-blocker are low.The patients′ poor compliance and doctors′ failing to prescribe in accordance with the guidelines of AMI are the main influencing factors on medications application in elderly patients with STEMI after discharge.