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目的评估2001-2011年间中国中部农村医院急性心肌梗死(acute myocardial infarction,AMI)患者住院期间他汀应用的变化趋势,并探讨其使用的影响因素。方法采用两阶段随机抽样设计,抽取中部农村AMI患者代表性样本。第一阶段,采用简单随机抽样确定协作医院。第二阶段,选取2001、2006和2011三个特定年份,在协作医院中采用系统随机抽样方法,抽取研究病历,提取临床信息,计算院内他汀使用率。采用广义估计方程的多水平logistic回归模型分析影响他汀使用的因素。结果共计35家医院1895份AMI病历纳入研究。2001-2011年,AMI患者院内他汀的加权使用率从2001年的11.0%增加到2006年的56.1%,和2011年的78.5%(趋势P值<0.001)。在三个研究年份中,整体而言,院内他汀的使用率随LDL-C水平的升高而增加,未测量LDL-C的患者他汀的使用率最低。多因素模型分析中,入院时有胸痛(OR=2.03;95%CI 1.03-4.02,P=0.041)、既往有冠心病史(OR=2.06;95%CI 1.21-4.53,P=0.008)的患者接受他汀治疗的比例更高。然而即使在各个年份当中,不同医院的他汀使用情况差异也非常显著。结论过去的十年间,我国中部农村A MI住院患者的他汀使用率大幅增长,指南对于他汀的推荐在临床实践中得到快速普及。但是,他汀应用仍然存在改善空间。
Objective To evaluate the trends of statin use in hospitalized patients with acute myocardial infarction (AMI) in rural hospitals of Central China from 2001 to 2011 and to explore the influencing factors of statin use. Methods A two-stage random sampling design was adopted to collect representative samples from AMI patients in rural areas of central China. In the first phase, a simple random sampling was used to identify collaborating hospitals. In the second stage, three specific years of 2001, 2006 and 2011 were selected. A systematic random sampling method was used in the collaborative hospitals to extract the medical records, extract the clinical information and calculate the rate of statin use in the hospital. Multi-level logistic regression models using generalized estimation equations were used to analyze the factors that influence statin use. Results A total of 1895 AMI cases from 35 hospitals were included in the study. In 2001-2011, the weighted in-hospital statin use in AMI patients increased from 11.0% in 2001 to 56.1% in 2006 and 78.5% in 2011 (trend P-value <0.001). Overall, in-hospital statin use increased with increasing LDL-C levels in the three study years, with the lowest rate of statin use in patients not measuring LDL-C. In the multivariate model analysis, there were chest pain (OR = 2.03; 95% CI 1.03-4.02, P = 0.041) at admission, patients with previous history of coronary heart disease (OR = 2.06; 95% CI 1.21-4.53, P = 0.008) A higher proportion of statins are treated. However, differences in statin use in different hospitals were significant even in all years. Conclusions Over the past decade, the statin use rate of hospitalized patients with AMI in the rural areas of central China has been significantly increased. The guidelines for statins are rapidly gaining popularity in clinical practice. However, there is still room for improvement in statin use.