加拿大女子大学医院Noah M Ivers团队探讨了干预措施对心肌梗死后长期依从性和心血管事件的影响。该成果在线发表于2020年6月10日的《英国医学杂志》。
为了测试可扩展的卫生系统干预措施，以改善近期发生心肌梗死的患者坚持二级预防治疗的长期依从性，研究组在加拿大安大略省的9个心脏中心进行了一项三臂、实用、盲法评估的随机对照试验。通过集中性心脏登记系统，研究组招募了2632名患有心肌梗死的梗阻性冠状动脉疾病患者，按1：1：1随机分配，876例接受常规护理，878例接受以用户为中心的设计程序开发的五封邮件，878例接受邮件加电话的全面干预。共同主要结局是完成心脏康复和坚持推荐用药。
在受访者中，常规护理组643人中有174人（占27％），仅邮件组628人中有200人（32％），全面干预组531人中有196人（37％）完成了心脏康复，校正后的优势比为1.55。在全面干预组中，一年后遵守服用0、1、2、3和4种药物类别的患者所占比率分别为11.7%、6.0%、14.4%、32.9%和35.0%，在仅邮件组中分别为12.5%、6.8%、13.6%、30.2%和36.8%，常规护理组则分别为12.2%、8.4%、13.1%、30.3%和36.1%，仅邮件与常规护理相比，优势比为0.98；全面干预与常规护理相比，优势比为0.99。
总之，通过邮件和电话进行的可扩展干预措施可增加心肌梗死后心脏康复的完成率，但不能提高坚持药物治疗的依从性。
附：英文原文
Title: Interventions supporting long term adherence and decreasing cardiovascular events after myocardial infarction (ISLAND): pragmatic randomised controlled trial
Author: Noah M Ivers, Jon-David Schwalm, Zachary Bouck, Tara McCready, Monica Taljaard, Sherry L Grace, Jennifer Cunningham, Beth Bosiak, Justin Presseau, Holly O Witteman, Neville Suskin, Harindra C Wijeysundera, Clare Atzema, R Sacha Bhatia, Madhu Natarajan, Jeremy M Grimshaw
Issue&Volume: 2020/06/10
Abstract: Objective To test a scalable health system intervention to improve long term adherence to secondary prevention treatments among patients who have had a recent myocardial infarction.
Design Three arm, pragmatic randomised controlled trial with blinded outcome assessment.
Setting Nine cardiac centres in Ontario, Canada.
Participants 2632 patients with obstructive coronary artery disease after a myocardial infarction, identified from a centralised cardiac registry.
Interventions Participants were randomised 1:1:1 to receive usual care, five mail-outs developed through a user centred design process, or mail-outs plus phone calls. The phone calls were delivered first by an interactive automated system to screen for non-adherence to treatment. Trained lay health workers followed up as necessary. Interventions were coordinated centrally but delivered from each patient’s hospital site.
Main outcome measures Co-primary outcomes were completion of cardiac rehabilitation and adherence to recommended medication. Data were collected by blinded assessors through patient report and from administrative health databases at 12 months.
Results 2632 patients (mean age 66, 71% male) were randomised: 878 to the full intervention (mail plus phone calls), 878 to mail only, and 876 to usual care. Of the respondents, 174 (27%) of 643 in the usual care group, 200 (32%) of 628 in the mail only group, and 196 (37%) of 531 allocated to the full intervention completed cardiac rehabilitation (adjusted odds ratio 1.55, 95% confidence interval 1.18 to 2.03). In the mail plus phone group, 11.7%, 6.0%, 14.4%, 32.9%, and 35.0% reported adherence to 0, 1, 2, 3, and 4 drug classes after one year, respectively, in comparison with 12.5%, 6.8%, 13.6%, 30.2%, and 36.8% in the mail only group, and 12.2%, 8.4%, 13.1%, 30.3%, and 36.1% in the usual care group, respectively (mail only v usual care, odds ratio 0.98, 95% confidence interval 0.81 to 1.19; full intervention v usual care, 0.99, 0.82 to 1.20).
Conclusions Scalable interventions delivered by mail plus phone can increase completion of cardiac rehabilitation after myocardial infarction but not adherence to medication. More intensive interventions should be tested to improve adherence to medication and to evaluate the association between attendance at cardiac rehabilitation and adherence to medication.
DOI: 10.1136/bmj.m1731
Source: https://www.bmj.com/content/369/bmj.m1731
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
