| Background: Coronary heart disease is the main cause of death in developed countries,with the improvement of people's eating habits and living standards,cardiovascular disease morbidity and mortality rate has also increased sharply in our country,which has become the main killer of people's health.The number of people with CHD is large,the follow-up risk and mortality of acute myocardial infarction survivors is 1.5-15 times than that of the general population.In recent decades,domestic and foreign cardiovascular field has been committed to the treatment and prevention of CHD,how to improve its level,in order to improve the long-term prognosis of patients is an urgent problem to be solved.Large-scale clinical randomized trials continue to develop and update,which provide a strong evidence-based medical evidence.International guidelines unanimously recommend that in addition to continuous changes in lifestyle,the use of anti-platelet,?-blockers,statins lipid-lowering drugs,angiotensinconverting enzyme inhibitor/angiotensin receptor antagonist(ACEI/ARB)these four drugs are as a cornerstone to the treatment of CHD secondary prevention.It can significantly reduce the incidence of cardiovascular events such as heart failure,stroke,sudden death or re-infarction,andimprove the survival rate of patients.Objective: To investigate the status of CHD secondary preventive medication and the effects associated with drug use,in order to understand the differences between clinical practice and guidelines,still further more to provide some reference for clinicians and to promote the standardization of medication.Methods: The clinical data we collected were about patients definite diagnosed of CHD from January 2011 to December 2015 in the cardiovascular department of our hospital.We used retrospective research methods,and recorded the general characteristics of the population,the discharge rate of four evidence-based CHD secondary prevention drugs,that included antiplatelet,statins,?-blockers and ACEI/ARB.And the influencing factors of drug use,which is statistically analyzed,that P<0.05 was significant.Results:(1)There were 1150 patients we got,806 males(70.1%)and 344females(29.9%),with an average age of 63.1±6.4 years old,of which about1/3 of patients with a history of myocardial infarction,more than 2/3 of patients received revascularization.The proportion of complications from high to low followed by hyperlipidemia 736 cases(64.0%),702 cases of hypertension(61.0%),414 cases of diabetes mellitus(36.0%),heart failure172 cases(15.0%),ischemic stroke 62 cases(5.4%),chronic kidney disease39 cases(3.4%);(2)The use of guideline recommended drug: anti-platelets98.5%,statin 97.8%,beta blockers 55.7%,ACEI/ARB with the lowest rate of 38.3%;(3)Multivariate regression analysis showed that antiplatelet and statins were highly effective in receiving revascularization,in hyperlipidemia and non-cardiac failure;?-blockers were significantly higher in patients with MI,hypertension,hyperlipidemia and heart failure;ACEI/ARB had higher rates in complications of hypertension and heart failure.Conclusion: From the case of secondary prevention of CHD,the use rate of antiplatelet and statins is higher,which can basically follow the guidelines.However,the use of beta blockers and ACEI/ARB is not ideal,there is a gap between the requirements contrast to the guidelines which need us to pay more attention.Therefore,we need to adhere to continue the education of doctors,while strengthen the management of patients with chronic diseases,and improve patients' awareness of the disease,that is helpful for them to increase the drug compliance,as far as possible to reduce the risk of death,and to improve the quality of life. |
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