Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
1
admin
1683-1764
1735-7322
10.18869/acadpub.tumj
000
000
000
fa
jalali
1402
8
1
gregorian
2023
11
1
81
8
online
1
fulltext
other
بررسی تطابق دارودرمانی بیماران دچار حمله قلبی NSTE-ACS مراجعه کرده به بیمارستان شهید چمران اصفهان با گایدلاین مربوطه در شش ماهه اول سال 1400: یک گزارش کوتاه
Evaluating the guidelines adherence in the management of NSTE-ACS referred to shahid chamran hospital within six-month period in 2021: a brief report
گزارش كوتاه
Brief Report
<span style="font-family:yekanYW;"><span style="font-size:12pt"><span style="line-height:102%"><span style="direction:rtl"><span style="unicode-bidi:embed"><b><i><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">زمینه و هدف:</span></span></i></b><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> هدف از انجام این مطالعه بررسی میزان تطابق روند دارودرمانی بیماران مبتلا به </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">NSTE-ACS</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> با گایدلاین </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">ESC2020</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> در بیمارستان شهید چمران اصفهان میباشد.</span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:102%"><span style="direction:rtl"><span style="unicode-bidi:embed"><b><i><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">روش بررسی:</span></span></i></b> <span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">مطالعه انجام شده یک مطالعه گذشتهنگر است که در مقطع زمانی شش ماهه (از فروردین </span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">۱۴۰۰</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> تا شهریور </span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">۱۴۰۰) </span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">بر روی پرونده </span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">۲۳۹</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> بیمار </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">NSTE-ACS</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> در بیمارستان شهید چمران اصفهان انجام گرفت. در این تحقیق پرونده بیماران از لحاظ اندیکاسیون تجویز و انتخاب نوع و دوز داروی تجویزی مورد بررسی قرار گرفت.</span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:102%"><span style="direction:rtl"><span style="unicode-bidi:embed"><b><i><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">یافتهها:</span></span></i></b> <span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">از </span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">۱۸</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> آیتم بررسی شده، در </span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">۱۴</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> مورد تطابق بالای </span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">%۹۵</span></span> <span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">گزارش شد. تطابق کمتر از </span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">۵۰</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">% با گایدلاین نیز در موارد انتخاب نوع داروی ضدپلاکت، اندیکاسیون و دوز تجویز شده از مهارکنندههای </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">GP2b3a</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> و انتخاب نوع آنتیکواگولانت مشاهده شد.</span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:102%"><span style="direction:rtl"><span style="unicode-bidi:embed"><b><i><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">نتیجهگیری:</span></span></i></b> <span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">مطالعه حاضر نشاندهندهی تطابق کلی نسبتاٌ بالایی در دارودرمانی بیماران </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">NSTEMI-ACS</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> با گایدلاین میباشد. اما در ارتباط با تجویز مهارکنندههای </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">GP2b3a</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> و انتخاب نوع داروی ضدپلاکت و آنتی کواگولانت تطابق ضعیفی مشاهده شد.</span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%"></span></span></span></span></span></span></span><br>
<div><span style="font-size:12pt"><span style="line-height:130%"><span new="" roman="" style="font-family:" times=""><b><i><span style="font-size:10.0pt"><span style="line-height:130%">Background:</span></span></i></b><span style="font-size:10.0pt"><span style="line-height:130%"> The purpose of this study was to evaluate the adherence to the ESC 2020 guideline for the management of NSTE-ACS patients admitted to Shahid Chamran Cardiology Hospital affiliated to Isfahan University of Medical Sciences in 2021.</span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:130%"><span new="" roman="" style="font-family:" times=""><b><i><span style="font-size:10.0pt"><span style="line-height:130%">Methods:</span></span></i></b><span style="font-size:10.0pt"><span style="line-height:130%"> In this retrospective study which was done during April 2021 to September 2021 we reviewed the hospital documents of 239 NSTE-ACS patients, in regard to prescribed medication during the admission period in Shahid Chamran Heart Center. Guideline-adherence was evaluated according to ESC2020 guideline. Totally 18 items were evaluated including Antiplatelet (Clopidogrel, Ticagrelor, and Prasugrel) Anticoagulant (Heparin or Enoxaparin), PPI, Statin, Beta blocker, and RAAS blockers (including ACEI/ARB or MRA). In each section the selected drug and the administered dose were compared with the guideline and the guideline adherence for each part was expressed as percent.</span></span></span></span></span></div>
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<div><span style="font-size:12pt"><span style="line-height:130%"><span new="" roman="" style="font-family:" times=""><b><i><span style="font-size:10.0pt"><span style="line-height:130%">Results:</span></span></i></b><b> </b><span style="font-size:10.0pt"><span style="line-height:130%">Almost complete guideline adherence was described for 12 out of 18 reviewed items (77%). However, guideline adherence in relation to the type of medicine chosen as an antiplatelet was reported to be very low, and only 1.2% of the cases received ticagrelor or prasugrel which are the guideline recommended antiplatelet agent. Additionally, most of the administered GP2b3a antagonist agents such as eptifibatide were not in accordance with the guideline (Guideline adherence 39.74%). Also, the choice of the anticoagulant agent was among the items with low guideline adherence (29.76%) and the cross-over between anticoagulants (changing heparin to enoxaparin or vice versa) which has been inhibited by the guideline was seen with high incidence in this center (78 cases).</span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:130%"><span new="" roman="" style="font-family:" times=""><b><i><span style="font-size:10.0pt"><span style="line-height:130%">Conclusion:</span></span></i></b><span style="font-size:10.0pt"><span style="line-height:130%"> The present study showed relatively high guideline adherence in the most aspects of medical management. However, compliance was reported to be low in relation to the antiplatelet selection, the choice of the anticoagulant agent, and the indication for GP2b3a antagonist use, which maybe due to the higher cost of recommended agents, and shortage of some medications and dosage forms in Iran.</span></span><span dir="RTL" lang="AR-SA" style="line-height:130%"><span style="font-family:"B Lotus""></span></span></span></span></span><br>
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سکته قلبی, تطابق, گایدلاین.
acute coronary syndrome, adherence, guideline.
610
615
http://tumj.tums.ac.ir/browse.php?a_code=A-10-3666-713&slc_lang=other&sid=1
Mohammad Mahdi
Gholamian
محمد مهدی
غلامیان