| BackgroundAcute coronary syndrome(ACS)refers to a group of clinical syndromes in which the rupture or invasion of atherosclerotic plaques in the coronary artery walls causing the occurrence of complete or incomplete occlusive thrombosis.The inpatient mortality rate caused by ACS has exceeded 5%.In the China Cardiovascular Disease Report 2017 published in 2018,the prevalence and mortality rate of cardiovascular disease in China is still on the rise.The number of patients with cardiovascular disease is estimated to be 290 million,of which there are about 11 million patients with coronary heart disease.Whether in urban or rural areas,cardiovascular deaths account for the first cause of total death in all residents.As a serious coronary heart disease,ACS is one of the main causes of cardiovascular mortality.With the increase in the prevalence and mortality of cardiovascular diseases,the burden of cardiovascular disease is increasing.As a major public health problem,the prevention and treatment of cardiovascular diseases cannot be delayed.Beta Receptor Blocker is the basic drug for cardiovascular diseases.It has the following effects on patients with acute coronary syndrome.First,it can reduce the infarct size and ease the patient's symptoms,.Second,it can reduce sudden death caused by myocardial ischemia,ventricular tachycardia,ventricular fibrillation and other malignant arrhythmias.Third,Beta Receptor Blocker can reduce myocardial remodeling,ischemic heart disease and heart failure,so that it can improve the long-term prognosis of patients with ACS.As early as the 1880s,the Gothenburg trial demonstrated that 90-day mortality and the incidence of recurrent myocardial infarction were reduced in patients with AMI who previously used beta receptor blockers.The ISAS-TC study retrospectively analyzed 5259 patients with ACS who took beta blockers within one day after onset can reduce inpatiental mortality by 62%.The Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction(CAPRICORN)trial definitively demonstrated the benefit of beta-blockers in patients with LV dysfunction(LVEF<40%)after MI with or without clinical signs of heart failure.Numerous guidelines point that the role of beta receptor blockers play a key role in the treatment of acute coronary syndromes.But in our clinical practice,the use of beta receptor blockers is not far from the guidelines.The PURE study indicated a significant difference in the use of beta receptor blockers in high-income countries and low-income countries,at 40.0%and 9.7%,respectively.Among them,the utilization rate in China is only 6.8%.China PEACE study showed that in 2011 and 2001,the use rate of ?-blockers in patients with acute myocardial Infarction(AMI)was 57.7%and 49.6%,respectively.There was no significant change in utilization rate of beta receptor blockers in 10 years(P=0.046).In 2013,a current state of investigation involving 13 078 patients with CHD indicated only 60%patients used the beta receptor blockers.Due to the insufficient dose of the beta blocker,the resting heart rate does not reach the target value,so the standardization of the use of the beta blocker needs to be further improved.Objective1.To observe the status of beta receptor blockers and the compliance of resting heart rate in patients with acute coronary syndrome during hospitalization and after discharge.2.To verify the safety of beta receptor blockers in patients with cute coronary syndrome.3.To provide evidence for standardized use of beta blockers in our clinical practice.MethodFrom November 2017 to March 2018,we collected the patients with acute coronary syndrome who is charged from the Department of Cardiology,Qilu Hospital of Shandong University.According to the inclusion criteria and exclusion criteria,a total of 196 patients were selected.We record the patient demographics,medical history,previous drug use history(mainly beta blockers),the use of beta blocker and other drugs,and other laboratory tests.After discharge,patients were followed up on site or by telephone at 1,3,6 and 12 months.Use of beta blockers including type and dose of beta blockers were recorded.Systolic Blood Pressure(SBP),Diastolic Blood Pressure(DBP)and Resting Heart Rate(RHR)were also recorded.The patient's basic information and follow-up information are recorded in an electronic file to establish a database.Database is analyzed using SPSS 23'0 software.Continuous variables will be analyzed using the statistical methods:N,mean,standard deviation(SD),median,interquartile range(IQR).All categorical variables of the observed value will be figured frequency and percentage.Baseline data such as basic characteristics,individual and family history of the study population will be summarized using descriptive statistics.Paired sample t-test and non-parametric test were used to analyze the data.P<0.05 indicated that the difference was statistically significant.Result1.At the end of the 12-month follow-up,the total mortality in this study was 3.0%(6/196).The remaining 190 patients completed follow-up at 1,3,6,and 12 months after discharge.2.(1)Situation of beta receptor blockers during hospitalization:On admission,4(2.0%)patients took metoprolol tartrate tablets,189(96.5%)patients took metoprolol succinate tablets,and 3(1.5%)patients took bisoprolol fumarate.73(37.2%)patients'beta blocker dose/target dose<1/4,116(59.1%)patients'beta blocker dose/target dose?1/4 and<1/2,7(3.6%)patients' beta blocker dose/target dose?1/2.At discharge:35(17.8%)patients' beta blocker dose/target dose<1/4,123(62.8%)patients' beta blocker dose/target dose?1/4 and<1/2,38(19.4%)patients'beta blocker dose/target dose?1/2.After drug adjustment during hospitalization,the dose of beta blocker at discharge increased,but the dose was still lower than the guideline.(2)RHR comparison during admission and discharge:73.3 ± 10.5 VS 68.3± 8.7(P<0.01).SBP comparison:135.3 ± 16.9vs118.4 ± 18.9(P<0.01).DBP comparison:77.1 ± 10.7vs 66.4± 10.1(P<0.01).At discharge,RHR was 37(18.8%)patients,RHR was at 55-60 beats/min.After drug adjustment during hospitalization,the patients' resting heart rate decreased at discharge,but low heart rate reached the standard3.Situation of beta receptor blockers in the 12 month after discharge.The patient's beta blocker use:10 patients stopped taking drugs,4(2.0%)patients took metoprolol tartrate tablets,178(99%)patients took metoprolol succinate tablets,and 2(1.0%)patients took bisoprolol fumarate.30(15.8%)patients' beta blocker dose/target dose<1/4,116(61.0%)patients' beta blocker dose/target dose?1/4 and<1/2,34(17.9%)patients' beta blocker dose/target dose?1/2.RHR comparison during discharge and after 12month:(68.3± 6.9)beats/min VS(68.3± 8.6)beats/min,P =0.99.SBP comparison:(125.2± 10.6)mmHg vs(118.3 ± 12.4)mmHg,P<0.01.DBP comparison(73.2 ± 9.4)mmHg vs(71.5 ± 9.4)mmHg,P = 0.01.There were 27(14.2%)RHR at 55-60 beats/min in 12 months after discharge.At 12 months after discharge from the hospital,the adjustment of the beta'blocker was not significant.The patients' RHR did not increase compared with that in discharge.4.During hospitalization,patients who increased the beta receptor blocker dosage accounted for 45.9%.After discharge,patients who increased the beta receptor blocker dosage accounted for 10.5%.5.Among the 10 patients who stopped taking medicine,9 patients stopped taking medicine by themselves,and only one patient stopped taking medicine according to the doctor's advice because his/her heart rate was lower than 50 beats per minute6.During hospitalization and 12 months after discharge,no patient's systolic blood pressure was below 90 mmHg,and only one patient's heart rate was below 50 beats/min.7.In the 12 months after discharge,19 patients(9.7%)were hospitalized for acute coronary syndrome,including 3 patients(1.5%)admitted to hospital due to myocardial infarction and 16 patients(8.2%)admitted to hospital due to unstable angina.Conclusion1.During the hospitalization,the dose adjustment of p-blockers was obvious,and the resting heart rate was significantly lower than that at admission.The target heart rate compliance rates both are low.2.The dose adjustment of beta blockers after discharge was not changed obviously.The target heart rate compliance rates3.p-blockers have good safety in acute coronary syndrome.In clinical work,more attention should be paid to the adjustment of ?-blockers,and the resting heart rate of patients should be met as soon as possible.4,The use dose of ?-blockers is low,and there is a certain gap with that recommendated by the guidelines. |
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