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目的对首次因心衰住院,出院处方用药趋势和预示因子以及证据性疗法对全因死亡率的作用进行调查。设计回顾多中心人群研究,医疗记录研究。设施西澳大利亚州,珀斯,三级保健医院。病人使用WA医院发病数据识别1996至2006年1 006例心衰住院病人随机样本。主要结果测量出院时,为心衰病人开出基于证据的处方比例;1年全因死亡率。结果研究期间,944例幸存出院病人中,所开出血管紧张素转换酶(ACE)抑制剂/血管紧张素受体阻滞剂(ARBs)(74.3%)、髓袢利尿剂(85.5%)的处方率比较高,而β-阻滞剂和安体舒通的处方率也有所增加(分别:10.5%～51.3%和1.4%～23.3%),地高辛处方率有所下降(38.1%～20.7%)。β-阻滞剂、安体舒通和地高辛短暂使用趋势在临床试验证据线内。≥75岁为用β-阻滞剂、安体舒通的明显负性预示因子。住院超声心动图,53%病人完成了此检查,更有可能与用ACE抑制剂/ARBs、β-阻滞剂、安体舒通治疗相关。出院处方用ACE抑制剂/ARBs和β-阻滞剂2种制剂与1年死亡较低校正HR相关(分别:HR,0.71;P=0.003;和HR,0.68;P=0.002)。结论因心衰首次住院期间用ACE抑制剂/ARBs和β-阻滞剂与改善病人长期幸存相关。除了用超声心动图作为基于证据疗法的重要预示因子,研究期间变得有更多证据的疗法未被充分采用。
Objective To investigate the effect of first hospitalization for heart failure, drug prescription trends and predictors of discharge from the hospital, and evidence-based therapy on all-cause mortality. Design Review Multi-center population studies, medical records studies. Facilities Western Australia, Perth, tertiary care hospital. Patients using the WA hospital incidence data to identify 1996-2006 random sample of inpatients with heart failure. The primary outcome measure was evidence-based prescribing for heart failure patients at discharge from hospital; 1-year all-cause mortality. Results During the study, angiotensin converting enzyme (ACE) inhibitor / angiotensin receptor blocker (ARBs) (74.3%) and medulla loop diuretic (85.5%) were given to 944 survivors, Prescription rates were high, and prescription rates for beta-blockers and spironolactone also increased (10.5% -51.3% and 1.4% -23.3%, respectively), and the prescribed rate of digoxin decreased (38.1% 20.7%). The short-term trends for β-blockers, spironolactone and digoxin are within the line of evidence from clinical trials. ≥ 75 years old with β-blockers, spironolactone significantly negative predictor. In-hospital echocardiography, done in 53% of patients, is more likely to be associated with treatment with ACE inhibitors / ARBs, beta-blockers, and spironolactone. Discharge prescriptions with ACE inhibitors / ARBs and beta-blockers were associated with lower 1-year mortality corrected HR (HR, 0.71; P = 0.003; and HR, 0.68; P = 0.002, respectively). CONCLUSIONS: ACE inhibitors / ARBs and beta-blockers were the first sign of improvement in long-term survival due to heart failure during their first hospitalization. In addition to using echocardiography as an important predictor of evidence-based therapy, therapies that became more evidenced during the study were underutilized.