Quality of care for secondary cardiovascular disease prevention in 2009-2017: population-wide cohort study of antiplatelet therapy use in Scotland.

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Inna Thalmann, David Preiss, Iryna Schlackow, Alastair Gray, Borislava Mihaylova
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Abstract

Background: Antiplatelet therapy (APT) can substantially reduce the risk of further vascular events in individuals with established atherosclerotic cardiovascular disease (ASCVD). However, knowledge regarding the extent and determinants of APT use is limited.

Objectives: Estimate the extent and identify patient groups at risk of suboptimal APT use at different stages of the treatment pathway.

Methods: Retrospective cohort study using linked NHS Scotland administrative data of all adults hospitalised for an acute ASCVD event (n=150 728) from 2009 to 2017. Proportions of patients initiating, adhering to, discontinuing and re-initiating APT were calculated overall and separately for myocardial infarction (MI), ischaemic stroke and peripheral arterial disease (PAD). Multivariable logistic regression and Cox proportional hazards models were used to assess the contribution of patient characteristics in initiating and discontinuing APT.

Results: Of patients hospitalised with ASCVD, 84% initiated APT: 94% following an MI, 83% following an ischaemic stroke and 68% following a PAD event. Characteristics associated with lower odds of initiation included female sex (22% less likely than men), age below 50 years or above 70 years (aged <50 years 26% less likely, and aged 70-79, 80-89 and ≥90 years 21%, 39% and 51% less likely, respectively, than those aged 60-69 years) and history of mental health-related hospitalisation (45% less likely). Of all APT-treated individuals, 22% discontinued treatment. Characteristics associated with discontinuation were similar to those related to non-initiation.

Conclusions: APT use remains suboptimal for the secondary prevention of ASCVD, particularly among women and older patients, and following ischaemic stroke and PAD hospitalisations.

2009-2017年二级心血管疾病预防的护理质量:苏格兰抗血小板治疗使用的人群队列研究。
背景:抗血小板治疗(APT)可以显著降低动脉粥样硬化性心血管疾病(ASCVD)患者发生进一步血管事件的风险。然而,关于APT使用的范围和决定因素的知识是有限的。目的:评估在治疗途径的不同阶段使用次优APT的风险范围并确定患者群体。方法:使用2009年至2017年因急性ASCVD事件住院的所有成年人(n=150728)的相关NHS苏格兰管理数据进行回顾性队列研究。针对心肌梗死(MI)、缺血性卒中和外周动脉疾病(PAD),分别计算启动、坚持、停止和重新启动APT的患者比例。使用多变量逻辑回归和Cox比例风险模型来评估患者特征在开始和停止APT中的作用。结果:在因ASCVD住院的患者中,84%开始APT:94%在MI后,83%在缺血性卒中后,68%在PAD事件后。与较低发病几率相关的特征包括女性(比男性低22%)、年龄在50岁以下或70岁以上(年龄结论:APT的使用对于ASCVD的二级预防仍然不理想,尤其是在女性和老年患者中,以及缺血性中风和PAD住院后。
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来源期刊
BMJ Quality & Safety
BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-
CiteScore
9.80
自引率
7.40%
发文量
104
审稿时长
4-8 weeks
期刊介绍: BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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