| Background Cardiovascular disease has become the leading cause of death and diability in the world. Acute myocardial infarction (AMI) is the emergency and severe case of coronary heart disease. It is estimated that by2030there will be23million patients with myocardial infarction in China, which will bring serious social and economic burden. A compelling evidence of science has demonstrated that antiplatelet therapy could reduce the incidence of death and improve the prognosis of patients with AMI. Therefore, antiplatelet therapy has become the cornerstone for the treatment of AMI. Clinical practice guidelines throughout the world consistently endorse the use of antiplatelet therapy as soon as possible after AMI. To investigate the current patterns of antiplatelet therapy among patients with AMI could inform practice and policy, and serve as a prelude for quality improvement initiatives to optimize treatment of patients with AMI in China.Objective The objectives of the study were to describe the temporal trends in national patterns of antiplatelet therapy for patients with AMI; to evaluate the presence of regional and hospital variation in the use of antiplatelet therapy; and to identify the characteristics of patients and hospital associated with the use of antiplatelet therapy.Methods We performed medical record abstraction for a nationally representative sample of patients with AMI from hospitals in China during2001,2006and2011.The type of antiplatelet, dosage and time were collected via central medical record abstraction with strict quality control.Results Among14,041eligible patients from162hospitals,12,988(92.5%) received aspirin therapy during hospitalization. The use of aspirin for AMI increased over time (84.7%in2001,92.3%in2006, and94.7%in2011). However, about14%of hospitals had a rate of use of less than80%in2011. Treatment was less likely in patients who presented with cardiogenic shock at admission, presented with cardiac arrest, or did not receive fibrinolytic therapy or percutaneous coronary intervention.Among the14,057eligible candidates for clopidogrel treatment, the rate of clopidogrel therapy increased remarkably over time (7.7%in2001,49.2%in2006,83.5%in2011). There was significant variation in early clopidogrel use by region, ranging from0%to11.8%in2001,4.5%to66.5%in2006and52.7%to93.2%in 2011. While the use of clopidogrel was uniformly high in urban hospitals in2011(median96.2%; interquartile range87.9%to99%), there was marked heterogeneity among rural hospitals (median60.8%; interquartile range13.3%to93.7%). Patients receiving fibrinolytic therapy or percutaneous coronary intervention and those admitted to teaching hospitals or hospitals with percutaneous coronary intervention capability were more likely to be treated.Among10,413eligible patients for tirofiban,1180(11.3%) patients received tirofiban therapy during hospitalization. The use of tirofiban for AMI increased over time from3.5%in2006to14.8%in2011. Patients who were older were less likely to receive tirofiban therapy. Patients receiving percutaneous coronary intervention and those admitted to urban hospitals or hospitals with percutaneous coronary intervention capability were more likely to receive tirofiban therapy.Conclusion While the utilization of antiplatelet therapy in patients with AMI has increased in China, there is persistent underuse, particularly in rural hospitals. Therefore, health administrative offices and medical orgnizations at all levels should establish policies to improve health care quality, make efforts to narrow the gap between clinical practice and evidence-based medicine and make use of antiplatelet therapy more scientific and reasonable. Meanwhile, medical organization should strengthen the clinicican education and make them fully understand the importance of antiplatelet therapy for patients with AMI. Only by the whole society muti-linkage, can improve the current insufficient use of antiplatelet therapy. |
PDF Full Text Request