脑梗死/短暂性脑缺血发作住院患者二级预防依从性研究及90天随访

目的 了解北京住院脑梗死/短暂性脑缺血发作(TIA)患者对于住院期间及出院90 d二级预防药物及行为修正的依从性现状.方法 调查2006年10月1日至2007年5月1日参加研究医院的符合入组标准的连续住院脑梗死及TIA患者对于肾素-血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)、他汀药物、抗血小板药物治疗的使用率,戒烟、控制体重等行为修正率并随访90 d.结果 入组患者中使用抗血小板及他汀等药物及行为修正率偏低,并且在出院90 d这一比例进一步降低.结论 医生应关注患者有明确循证医学依据的二级预防药物及行为修正的依从性,并采取行之有效的措施提高患者药物治疗及行为修正的依从性.

A survey on cerebral infarction/transient ischemic attack inpatiants compliance with secondary stroke prevention and follow-up 90 days

Objective Poor compliance with evidence-based-medicine guidelines could significantlyinfluence the effect of stroke prevention strategies. The objectives of this survey are to investigate the currentstatus in Beijing of cerebral infarction/TIA(transient ischemic attack) inpatients' adherence to the evidence-based- medicine secondary prevention and behavior modifications both at the discharge and at 90-day followup. Methods The survey included cerebral infarction/ TIA patients successively admitted from 1, Oct2006 to 1, May 2007, used ACEI/ARB, Statin, anti-platelet agents therapy, accepted carotid endarterctomyor angioplasty or stentt, and modified behaviors to stop smoking and control weight. Data of patients duringhospitalization were obtained from the medical documents in the inpatient department of 7 centers. Thedetailed information included the medicine therapy, lifestyle modifications, patients' social demographicbackground (age, sex, education and way of payment), major risk factors for stroke, and ischemic eventsubtypes (TLA or cerebral infarction). Above information of part of patients were collected through telephoneinterview at 90- day follow-up if the patients were not able to visit the clinic. Results 708 cerebralinfarction/TIA inpatients who didn't have contraindicatious were included. Among them, the patents whohaven't used anti-platelet agents, nor taken statin, nor accepted ACEI/ARB were about 0.4%, 41.8% and63.6% respectively. Neither 27% of the patients have accepted the instructions on stop smoking. Whileabout 588 patients suitable to drug therapy were followed up at 90 days, but the percentage of these patientswho haven't compliance on anti-platelet agents, statin, ACEI/ARB was 26.9%, 52.6% and 59.4%respectively. Only 66.9% of the smoking patients have received the doctor instructions on smokingcessation. Conclusion Stroke recurrence rate in China is higher than that of average figures in westerncountries. One of the key reasons of high recurrence of stroke in China is the poor adherence to strokesecondary prevention guidelines. Thus, investigate current status of secondary prevention among hospitals incapital of China and promote strategies to enhance the adherence to the guidelines and fill the gap betweenthe clinical practice and evidence-based medicine in China, which is able to lower the stroke recurrence andsave byes are urgently needed. Physician should take great care of the patient's compliances on theevidenced-based- medicine secondary prevents and behavior modifications, and take effective measures toimprove the compliances.