心血管复方药策略对用药负担的影响。
The Effect of a Cardiovascular Polypill Strategy on Pill Burden.
机构信息
Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia.
出版信息
Cardiovasc Ther. 2015 Dec;33(6):347-52. doi: 10.1111/1755-5922.12151.
AIMS
Recent trials of cardiovascular polypills in high-risk populations show improvements in the use of cardiovascular preventive treatments, compared to usual care. We describe patterns of pill burden in Australian practice, define the impact of polypill therapy on pill burden, and explore how physicians add medication to polypill therapy.
METHODS
The Kanyini Guidelines Adherence with the Polypill Study was an open-label trial involving 623 participants in Australia which randomized participants to a polypill strategy (containing a statin, antiplatelet agent, and two blood-pressure-lowering medications) or usual care. Participants either had established cardiovascular disease or were at high calculated risk (≥15% over 5 years). Current medications, daily pill burden, and self-reported use of combination treatment were recorded prior to randomization and at study end. Median pill burden at baseline and study end was compared in both arms. Subgroup analysis of the polypill strategy on trial primary outcomes was conducted by pill burden at baseline.
RESULTS
Median total and cardiovascular pill burdens of the polypill group decreased from 7 to 5 and from 4 to 2, respectively (median change -2; IQR -3, 0), with no change in the usual care group (comparison of change; P < 0.001). No change was seen for noncardiovascular medications. Of those still using the polypill at study end, 43.8% were prescribed additional medications; 84.5% of these additional medications were blood-pressure-lowering medications. Within the polypill group, lower pill burden at baseline was associated with greater increases in the use of indicated cardiovascular preventive medications at study end compared to those with higher pill burdens. No trend was observed between the level of baseline pill burden and the effect of poylpill treatment on systolic blood pressure or total cholesterol.
CONCLUSION
A cardiovascular polypill in contemporary Australian practice reduces cardiovascular and total pill burdens, despite frequent prescription of additional medications.
目的
最近在高危人群中进行的心血管复方药试验表明，与常规护理相比，心血管预防治疗的使用率有所提高。我们描述了澳大利亚实践中的药丸负担模式，定义了复方药治疗对药丸负担的影响，并探讨了医生如何将药物添加到复方药治疗中。
方法
Kanyini 指南依从性与复方药研究是一项在澳大利亚进行的开放性试验，涉及 623 名参与者，将参与者随机分为复方药策略组（包含他汀类药物、抗血小板药物和两种降压药物）或常规护理组。参与者要么患有已确立的心血管疾病，要么处于高计算风险（≥5 年内 15%）。在随机分组前和研究结束时记录当前药物、每日药丸负担和报告的联合治疗使用情况。比较了两组基线和研究结束时的中位数药丸负担。根据基线时的药丸负担对试验主要结局进行了复方药策略的亚组分析。
结果
复方药组的总药丸负担和心血管药丸负担中位数从 7 降至 5，从 4 降至 2，分别下降 2（中位数变化 -2；IQR -3，0），常规护理组无变化（变化比较；P < 0.001）。非心血管药物无变化。在研究结束时仍使用复方药的患者中，有 43.8%被开了额外的药物；这些额外药物中有 84.5%是降压药物。在复方药组中，与基线时较高的药丸负担相比，基线时较低的药丸负担与研究结束时更增加了指示性心血管预防药物的使用有关。未观察到基线药丸负担水平与复方药治疗对收缩压或总胆固醇的影响之间存在趋势。
结论
在当代澳大利亚实践中，心血管复方药降低了心血管和总药丸负担，尽管经常开处方添加额外的药物。
Zotero 插件