中国药物警戒 ›› 2021, Vol. 18 ›› Issue (2): 126-132.
DOI: 10.19803/j.1672-8629.2021.02.06

• 基础与临床研究 • 上一篇    下一篇

多重用药对老年冠心病合并心房颤动患者远期预后的影响

董敏1, 邹彤1, 徐蕾2, 何清华3, 裴作为1, 汪芳1,*   

  1. 1北京医院心内科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730;
    2北京医院神经内科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730;
    3北京医院内分泌科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730
  • 收稿日期:2020-05-27 修回日期:2021-02-26 出版日期:2021-02-15 发布日期:2021-02-26
  • 通讯作者: *汪芳,女,主任医师,教授,心内科。E-mail：35133385@qq.com
  • 作者简介:董敏,女,主治医师,心内科。
  • 基金资助:
    十三五国家科技重大新药创制专项课题（2017ZX09304026）; 首都卫生发展科研专项（重点）（首发2016-1-4051）

Effects of Polypharmacy on Long-term Prognosis of Elderly Patients with Coronary Heart Disease and Atrial Fibrillation

DONG Min1, ZOU Tong1, XU Lei2, HE Qinghua3, PEI Zuowei1, WANG Fang1,*   

  1. 1Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing100730, China;
    2Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing100730, China;
    3Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing100730, China
  • Received:2020-05-27 Revised:2021-02-26 Online:2021-02-15 Published:2021-02-26

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摘要： 目的 探讨多重用药对老年冠心病合并心房颤动患者远期预后的影响。方法 选取2013年1月1日至2015年3月31日期间本院收治的65岁及以上冠心病合并房颤患者,并进行回顾性病例调查,结合电话、门诊及住院病例查询等方式随访至少5年,评价不同用药种类的患者出现肝肾功能变化、药品不良反应（ADR）及主要不良心脑血管事件（MACCE）的差异。结果 共295例患者纳入本研究,平均年龄（79.2±5.9）岁,80岁以上高龄老年患者141例（47.8%）。平均患病种类（6.5±1.9）种,平均用药种类（8.3±3.2）种,用药在5种以上患者共267例（90.5%）,采取抗血小板治疗者223例（75.6%）,抗凝治疗63例（21.4%）。在不同年龄段患者中,根据患者用药种类分为多重用药A组（用药≥8种）和多重用药B组（用药<8种）。低龄老年组（年龄< 80岁）中,A组患者合并陈旧性心肌梗死和心力衰竭的比例较B组更高（分别为36.0%比21.5%,52.0%比31.6%,P<0.05）。高龄老年组（年龄≥80岁）中,A组患者NYHA心功能分级较B组更差（2.2±0.9比2.1±1.0,P<0.05）。在长达至少5年的随访中,无论哪个年龄组的老年患者,A组患者的MACCE和心力衰竭发生率显著高于B组（P<0.05）,出血发生率略高于B组（P>0.05）,但A、B 组患者的谷丙转氨酶（ALT）、谷草转氨酶（AST）、肾小球滤过率（GFR）的变化、ADR及死亡率的差异没有统计学意义（P>0.05）。结论 多重用药在老年冠心病合并房颤患者中非常普遍,尤其是在合并陈旧性心肌梗死和心力衰竭的患者中比例更高。随访中,除了出血风险略高于其他人群,尚未发现多重用药导致的肝肾功能恶化、其他ADR和死亡率增加。因此,在诊治这类心血管高危人群时,应当给予全面优化的药物治疗方案,在保证疗效的前提下精简治疗方案,争取最佳预后。

关键词: 老年人, 老年共病, 多重用药, 冠心病, 心房颤动, 不良心脑血管事件

Abstract: Objective To explore the effect of polypharmacy on the long-term prognosis of elderly patients with coronary heart disease and atrial fibrillation. Methods Patients aged over 65 years with coronary heart disease and atrial fibrillation were studied and followed up for a minimum of 5 years via the telephone, outpatient and inpatient case inquiry. The difference in liver and kidney function,adverse drug reactions (ADR) and major adverse cardiovascular and cerebrovascular events (MACCE) in patients using different types of drugs was studied. Results A total of 295 patients were included in the study, with an average age of （79.2±5.9） years. In addition, 141 (47.8%) of these patients were over 80 years old. Each of them was afflicted with (6.5±1.9) kinds of diseases and used (8.3±3.2) types of dispensed drugs on average. 267 of these patients (90.5%) were treated with more than 5 types of dispensed drugs, 223 (75.6%) with antiplatelet therapy and 63 (21.4%) with anticoagulation. In different age groups, patients were divided into polypharmacy group A (dispensed drugs≥8) and polypharmacy group B (dispensed drugs<8) according to the types of medication. In the younger group（aged<80 years）, the proportion of old myocardial infarction and heart failure in group A was higher than that in group B (36.0% vs 21.5%, 52.0% vs 31.6%, respectively, P<0.05). In the older group（aged≥80 years）, NYHA heart function grade in group A was worse than that of group B (2.2±0.9 vs 2.1±1.0, P<0.05). During the follow-up of at least 5 years, the incidence of MACCE and heart failure in group A was significantly higher than that in group B in both age groups (P<0.05), and the incidence of bleeding was slightly higher in group A (P> 0.05), but there was no significant difference between the two groups in the changes of ALT, AST, GFR, ADR or death rate (P>0.05). Conclusion Polypharmacy is not uncommon in elderly patients with coronary heart disease and atrial fibrillation, especially in patients with old myocardial infarction and heart failure. During the follow-up, no deterioration of liver and kidney function, ADR or increased mortality have been found except for the slightly higher risk of bleeding. Therefore, the diagnosis and treatment of this cardiovascular high-risk population requires a comprehensive and optimized drug treatment scheme that can be simplified as long as the curative effect can be ensured to achieve the best possible prognosis

Key words: elderly, multi-morbidity, polypharmacy, coronary heart disease, atrial fibrillation, adverse cardiovascular and cerebrovascular events

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