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1、ImplementingNCEPandAHA/ACCGuidelines:ImpactofNewEvidenceGreggC.Fonarow,MD1970s1988EvolutionoftheNCEPGuidelines19932001ATPIATPIIATPIIIFraminghamMRFITLRC-CPPTCoronaryDrugProjectHelsinkiHeartStudyCLAS(angio)AngiographicTrials(FATS,POSCH,SCOR,STARS,Ornish,MARS)
2、Meta-Analyses(Holme,Rossouw)4S,WOSCOPS,CARE,LIPID,AFCAPS/TexCAPS,VA-HIT,othersDeaths(inThousands)79818387899599YearsAmericanHeartAssociation.2002HeartandStrokeStatisticalUpdate.Dallas,Texas:AHA,2001.CardiovascularDiseaseDeaths:UnitedStates1979–1999919785930
3、WomenMenNCEPINCEPIINCEPIIIAdherencetoNCEPTreatmentGoalsinPatientswithCHD:QualityAssuranceProgramSuetaCAetal.AmJCardiol1999;83:1303-1307.LDL<100,onRxLDL<100,noRxLDL>100,onRxLDL>100,noRxNoLDL,onRxNoLDL,noRx7%5%18%16%12%42%n=58,890;140USpractices,chartaudit7/9
4、4–10/96UtilizationofLipid-LoweringMedicationsatDischargeinPatientswithAMI:NationalRegistryofMyocardialInfarction(NRMI)3FonarowGCetal.Circulation2001;103:38-44.CVEvents%DischargedonLipidTherapyMale(n=83,806)P<0.0001Female(n=54,195)Age(Years)P<0.0001P<0.0001P
5、=NSP=NS<5555–6465–7475–8485+138,001patientsdischargedfrom1470UShospitals,July1998toJune1999CHDPatient"Treatment"GapFonarowGCetal.Circulation2001;103:38-44.
6、SuetaCAetal.AmJCardiol1999;83:1303-1307.
7、PearsonTAetal.JAmCollCardiol1998;31:88A.
8、PearsonTAetal.ArchI
9、nternMed2000;160:459-467.HospitalSettingOutpatientSetting<40%CVhospitalizedpatientsdischargedonRx<30%withLDL<100at6monthspostdischargeBurdenofDiseaseBurdenofDisease6.3millionannualCHDdischargesintheUS25millionCHDpatientsintheUSNRMI/ACCEPTDataQAP/L-TAPData<5
10、0%CHDpatientsreceivinglipidRx<20%withLDL<100(atgoal)CHDPatientTreatmentGap:CommunityPearsonTAetal.ArchInternMed2000;160:459-467.18Providerawarenessdoesnotequalsuccessfulimplementation95PhysicianAwarenessofNCEPGuidelinesPatientTreatedtoGoalPercentCHDPatientT
11、reatmentGap:AcademicCentersCVEvents%CADPatientsTreatedBrighamandWomen’s(1996)AnacademicenvironmentdoesnotequalsuccessfulimplementationAbookireSAetal.ArchInternMed2001:161:53-58.
12、MuhlesteinJBetal.AmJCar
