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首页> 外文期刊>Scandinavian journal of primary health care. >Drug prescription rates in secondary cardiovascular prevention in old age: Do vulnerability and severity of the history of cardiovascular disease matter?
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Drug prescription rates in secondary cardiovascular prevention in old age: Do vulnerability and severity of the history of cardiovascular disease matter?

机译：老年继发性心血管疾病预防中的药物处方率：心血管疾病史的脆弱性和严重性是否重要？

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Objective: To assess the influence vulnerability and severity of cardiovascular disease (CVD), on prescription rates of secondary cardiovascular preventive drugs in old age.Design: Population-based observational study within the ISCOPE study. Setting: General practices in the Netherlands.Subjects: A total of 1350 patients with a history of CVD (median age 81 years, 50% female).Main outcome measures. One-year prescription rates of lipid-lowering drugs and antithrombotics were obtained from the electronic medical records of 46 general practitioners (GPs). Prescription of both drugs for270 days per year was considered optimal. GPs made a judgement of vulnerability. Severity of CVD was expressed as major (myocardial infarction, stroke, or arterial surgery) versus minor (angina, transient ischaemic attack, or claudication).Results: GPs considered 411 (30%) participants to be vulnerable and 619 (55%) participants had major CVD. Optimal treatment was prescribed to 680 (50%) participants, whereas 370 (27%) received an antithrombotic drug only, 53 (4%) a lipid-lowering drug only, and 247 (18%) received neither. Optimal treatment was lower in participants aged85 years (OR 0.37 [95% CI 0.29-0.48]), in females (OR 0.63 [0.50-0.78]), in vulnerable persons (OR 0.79 [0.62-0.99]) and in participants with minor CVD (OR 0.65 [0.53-0.81]). Multivariate ORs remained similar whereas vulnerability lost its significance (OR 0.88 [0.69-1.1]).Conclusion: In old age, GPs' judgement of vulnerability is not independently associated with lower treatment rates of both lipid-lowering drugs and antithrombotics, whereas a history of minor CVD is. Individual proactive re-evaluation of preventive treatment in older (female) patients, especially those with a history of minor CVD, is recommended.
机译：目的：评估对老年心血管辅助药物处方率的影响脆弱性和心血管疾病（CVD）的严重程度。设计：ISCOPE研究中基于人群的观察性研究。地点：荷兰的一般做法。受试者：共有1350名有CVD史的患者（中位年龄81岁，女性占50％）。主要结局指标。降脂药和抗血栓药的一年处方率来自46名全科医生的电子病历。两种药物每年270天的处方被认为是最佳的。全科医生对脆弱性做出判断。 CVD的严重程度表示为严重（心肌梗塞，中风或动脉手术）与轻微（心绞痛，短暂性脑缺血发作或c行）比较。结果：全科医生认为411（30％）的参与者是脆弱的，而619（55％）的参与者是脆弱的患有严重的CVD。对680名（50％）参与者规定了最佳治疗，而370名（27％）仅接受抗血栓药物，53名（4％）仅接受降脂药物，而247名（18％）均未接受。年龄在85岁以上的参与者（OR 0.37 [95％CI 0.29-0.48]），女性（OR 0.63 [0.50-0.78]），弱势人群（OR 0.79 [0.62-0.99]）和未成年参与者的最佳治疗率较低CVD（OR 0.65 [0.53-0.81]）。多变量OR仍然相似，而脆弱性则失去了意义（OR 0.88 [0.69-1.1]）。结论：在老年患者中，GP的脆弱性判断与降脂药和抗血栓药的治疗率降低并不独立相关，而历史悠久轻微的CVD是。建议对年龄较大（女性）的患者，特别是有轻度CVD史的患者进行预防性治疗的前瞻性重新评估。

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