动脉粥样硬化性心血管疾病的临床负担和管理缺口：2017-2023年台湾687,212例患者的全国性研究

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-07-16 DOI:10.1016/j.ijcha.2025.101749

Fei-Yuan Hsiao , Yi-Heng Li , Hsi-Yu Lai , Lin-Chieh Meng , Hui-Min Chuang , Ho-Min Chen , Chung-Liang Shih , Wen-Jone Chen

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引用次数: 0

摘要

目的本研究旨在分析台湾住院动脉粥样硬化性心血管疾病（ASCVD）发病率的时间趋势，评估血脂检测模式和目标达成率，并评估ASCVD患者的医疗保健利用情况。我们计算了年龄标准化发病率，并分析了降脂治疗模式、低密度脂蛋白胆固醇（LDL-C）检测以及指数住院期间和一年随访期间的医疗保健利用情况。结果在687,212例ASCVD患者中，从2017年到2023年，年龄标准化发病率下降了10%（从每10万人-年256.3例降至231.8例），性别差异明显（男女比：1.73）。发病率在20-29岁（12.6%）和70-79岁（19.0%）的成年人中有所增加。在所有ASCVD亚型中，缺血性心脏病（IHD）的校正发病率最高（99.86 / 100,000人-年）。指数住院期间LDL-C检测率为次优（64.8%），不同ASCVD亚型之间存在显著差异（卒中最高：80.2%，外周动脉疾病最低：39.2%）。只有34.1%的患者在出院一年后LDL-C达到70 mg/dL。住院期间降脂治疗起始率较低（48.9%），3个月时达到峰值（60.9%），随后稳定在57%。出院后1年内急诊科就诊率为40.8%，再住院率为40.6%，1年内死亡率为13.2%。结论我们的研究结果显示台湾医疗系统在ASCVD护理和脂质管理方面存在巨大差距，强调了改善这一高危人群预防策略和优化心血管结局的关键机会。

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Clinical burden and management gaps in atherosclerotic cardiovascular disease: A nationwide study of 687,212 patients in Taiwan, 2017–2023

Objective

This nationwide study aimed to analyze temporal trends in hospitalized atherosclerotic cardiovascular disease (ASCVD) incidence, evaluate lipid testing patterns and goal attainment rates, and assess healthcare utilization among ASCVD patients in Taiwan.

Methods

Using Taiwan’s National Health Insurance database linked with laboratory data (2017–2023), we identified patients with incident hospitalized ASCVD. We calculated age-standardized incidence rates and analyzed lipid-lowering therapy patterns, low-density lipoprotein cholesterol (LDL-C) testing, and healthcare utilizations during index hospitalization and one-year follow-up.

Results

Among 687,212 patients with incident ASCVD, age-standardized incidence decreased by 10% (from 256.3 to 231.8 per 100,000 person-years) from 2017 to 2023, with marked sex disparities (male-to-female ratio: 1.73). Concerning increases in incidence were observed among adults aged 20–29 (12.6%) and 70–79 (19.0%). Among all subtypes of ASCVD, ischemic heart disease (IHD) showed the highest adjusted incidence (99.86 per 100,000 person-years). LDL-C testing rates were suboptimal during index hospitalization (64.8%), with significant variation across ASCVD subtypes (highest in stroke: 80.2% and lowest in peripheral artery disease: 39.2%). Only 34.1% achieved LDL-C <70 mg/dL at one year post-discharge. Lipid-lowering therapy initiation was low during hospitalization (48.9%), peaked at 3 months (60.9%), then stabilized at 57%. Within one year post-discharge, 40.8% had emergency department visits, 40.6% were rehospitalized, and one-year mortality rate reached 13.2%.

Conclusion

Our findings reveal substantial gaps in ASCVD care and lipid management in Taiwan’s healthcare system, highlighting critical opportunities for improving preventive strategies and optimizing cardiovascular outcomes in this high-risk population.

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.