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Heart:电话随访明显改善支架置入后患者服药依从性

2013-02-27 晓静 编译 医学论坛网

  加拿大学者的一项研究表明,对药物洗脱支架(DES)置入后患者采取简单的4次电话回访可明显改善其1年的服药依从性,这一简单的干预方式也可显著改善双联抗血小板治疗(DAT)的持久性。相关论文2013年2月23日在线发表于《心脏》(heart)杂志。   该研究共纳入300例DES置入后的患者,将其随机分为干预组和对照组。为加强患者服药依从性,对干预组患者进行4次的电话随访,时间分别为DES

  加拿大学者的一项研究表明,对药物洗脱支架(DES)置入后患者采取简单的4次电话回访可明显改善其1年的服药依从性,这一简单的干预方式也可显著改善双联抗血小板治疗(DAT)的持久性。相关论文2013年2月23日在线发表于《心脏》(heart)杂志。

  该研究共纳入300例DES置入后的患者,将其随机分为干预组和对照组。为加强患者服药依从性,对干预组患者进行4次的电话随访,时间分别为DES置入后7天内、第1、6、9个月;对安慰剂组患者进行常规诊疗活动的随访。收集药房数据以评估药物处方填充和再填充信息。主要终点为药房再填充数据评估发放后1年期间覆盖阿司匹林和氯吡格雷治疗的天数比例。次要评估指标包括患者阿司匹林和氯吡格雷治疗的持久性(定义为随访期间中断药物时间不超过14天)。

  结果显示,大多数(73%)患者因急性冠脉综合征(ACS)而置入了DES。所有患者均有药物保险,公共保险59%,私人保险41%。获得了96%队列人群中的完全药房随访数据。12个月时,阿司匹林和氯吡格雷依从性中位评分在电话干预组中分别为99.2% 和99.3%;在对照组分别为90.2%and 91.5%(p<0.0001)。电话干预组比对照组的阿司匹林和氯吡格雷治疗显著更持久。对于氯吡格雷,电话干预组中有87.2%的患者在12月时仍坚持治疗,而在对照组只有43.1%(p<0.0001)。


Telephone contact to improve adherence to dual antiplatelet therapy after drug-eluting stent implantation

Background 
Many patients delay or interrupt dual antiplatelet therapy (DAT) after drug-eluting stent (DES) implantation, which increases the risk of stent thrombosis and death.
Objective 
To test the hypothesis that simple telephone contact made by nurses would improve adherence to and persistence of DAT.
Design 
Randomised controlled trial.
Patients and intervention 
A total of 300 patients (mean±SD 64±10 years, 73% male) were recruited immediately after DES implantation performed between June 2009 and June 2010. The last patient recruited reached the 1-year follow-up time point in June 2011. Patients were randomised to one of two groups: intervention, with four telephone follow-ups, versus a control group. In the intervention group, phone calls were made within 7 days of the DES implantation and at 1, 6 and 9 months to support drug adherence. Control patients were followed as per usual clinical practice. Pharmacy data were collected to assess drug prescription filling and refill.
Setting 
Tertiary care university cardiovascular centre and community.
Main outcome measures 
The primary end point was the proportion of days covered with aspirin and clopidogrel over the year after discharge as assessed by pharmacy refill data. Secondary outcome measures included persistence of aspirin and clopidogrel treatment, defined as no gaps longer than 14 days during follow-up.
Results 
Most patients (73%) underwent DES implantation in the context of an acute coronary syndrome. All patients had drug insurance cover, either from the public plan (59%) or through private plans (41%). Complete pharmacy follow-up data were available for 96% of the cohort. At 12 months, median scores (25th–75th centile) for adherence to aspirin and clopidogrel were 99.2% (97.5–100%) and 99.3% (97.5–100%), respectively, in the intervention group compared with 90.2% (84.2–95.4%) and 91.5% (85.1–96.0%), respectively, in the control group (p<0.0001 for aspirin and clopidogrel). Patients in the intervention group were significantly more persistent in the aspirin and clopidogrel treatment than those in the control group. For clopidogrel, 87.2% of patients in the intervention group were still persistent at 12 months compared with only 43.1% in the control group (p<0.0001).
Conclusions 
A simple approach of four telephone calls to patients after DES implantation significantly improved 1-year drug adherence to near-perfect scores. Persistence of DAT was also significantly improved by the intervention.

    

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    2013-03-01 fyxzlh
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    2013-03-01 zhaojie88
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    2013-03-01 slcumt

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