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Fréquence d'utilisation des différents traitements de l'infarctus du myocarde dans deux régions suisses

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Sozial- und Präventivmedizin/Social and Preventive Medicine

Résumé

Deux régions suisses (Vaud-Fribourg et Tessin) participent au projet international MONICA patronné par l'OMS (MONItoring of trends and determinants in CArdiovascular disease). Dans ce cadre, toutes les hospitalisations des hommes pour maladie ischémique du coeur, sont enregistrées pendant une période de 10 ans. Les cas sont classés selon des critères uniformes en trois catégories: infarctus certain, infarctus possible ou pas d'infarctus. En 1986, l'étude a été complétée par un relevé des traitements. Dans cet article, l'analyse principale des soins se limite aux patients âgés de 25 à 64 ans survivant à 27 jours et porte sur 334 cas avec un infarctus certain (VD-FR: 217; TI: 117). Les résultats montrent que les anticoagulants étaient administrés de manière routinière (97% des cas) alors que la thrombolyse, pratiquée en 1986 par un seul hôpital dans chaque région, ne touchait que 9% des patients. La région romande se distinguait du Tessin par un usage significativement plus fréquent d'antiarythmiques (69% contre 47%; p<0.005), de dérivés nitrés (97% contre 86%; p<0.005) et de bêta-bloquants (57% contre 43%; p<0.05). En plus, les patients romands séjournaient plus longtemps aux soins intensifs (6.4 contre 3.7 jours; p<0.005) et bénéficiaient plus fréquemment d'un programme de réhabilitation (47% contre 12%; p<0.005). La discussion situe la pratique thérapeutique par rapport aux résultats publiés dans la littérature.

Summary

Two regions in Switzerland (Vaud-Fribourg and Ticino) participate in the WHO MONICA project (MONItoring of trends and determinants in CArdiovascular disease). Within this context, all hospitalizations of men for ischemic heart disease will be recorded during a period of ten years. All cases are classified according to uniform criteria, in three categories: definite myocardial infarction, possible myocardial infarction or no myocardial infarction. In 1986, the records were completed with a summary of treatments. The treatment of 334 patients with definite myocardial infarction, aged between 25 and 64 years, surviving after 27 days are analyzed (VD-FR: 217; TI: 117). Results show that anticoagulants were administred in a routine fashion (in 97% of the cases), whilst thrombolysis, applied in 1986 by only one hospital in each area, concerned only 9% of the patients. As compared to Ticino, VD-FR distinguished itself by its significantly higher use of antiarythmic drugs (69% versus 47%; p<0.005), nitrates (97% versus 86%; p<0.005) and beta-blockers (57% versus 43%; p<0.05). Furthermore, patients from VD-FR spent more time in the intensive care unit (6.4 versus 3.7 days; p<0.005) and participated more frequently in rehabilitation programmes (47% versus 12%; p<0.005). The discussion situates the observed therapy in relation to results published in the litcrature.

Zusammenfassung

Die Schweiz beteiligt sich mit zwei Gebieten (Waadt-Freiburg und Tessin) am Monica-Projekt der Weltgesundheitsorganisation (MONItoring of trends and determinants in CArdiovascular disease). In diesem Zusammenhang werden alle Hospitalisationen von Männern, die an einer ischämischen Herzkrankheit leiden, über einen Zeitraum von 10 Jahren registriert. Die registrierten Fälle werden nach einheitlichen Kriterien klassiert als eindeutiger Fall von Herzinfarkt, möglicher Herzinfarkt oder als „kein Infarkt”. Für das Jahr 1986 wurde die Studie mit einer Erhebung der Therapiemassnahmen ergänzt. Es werden für die 25-64jährigen Patienten mit eindeutigem Herzinfarkt die Therapien in den beiden Studienregionen analysiert. Es sind dies 334 Hospitalisationen (VD-FR: 217; TI: 117). Die Resultate zeigen, dass der Einsatz von Antikoagulantien allgemein üblich war (97% der Infarkte), während die Thrombolyse, deren Anwendung in beiden Studiengebieten auf ein Spital beschränkt war, nur 9% der Patienten betraf. Für die französischsprachige Region stellt man eine im Vergleich zum Tessin signifikant häufigere Anwendung von Antiarythmika (69% gegen 47%; p<0,005), Nitraten (97% gegen 86%; p<0,005) und Beta-Blockern (57% gegen 43%; p<0,05) fest. Die Patienten im Welschland bleiben zudem länger auf der Intensivpflegestation (6,4 gegen 3,7 Tage; p<0,005) und mehr von ihnen profitieren von einem Rehabilitationsprogramm (47% gegen 12%; p<0,005). In der Diskussion wird die angewendete Therapie mit den Resultaten klinischer Studien verglichen.

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Authors and Affiliations

  1. Institut universitaire de médecine sociale et préventive, 17. rue du Bugnon, CH-1005, Switzerland

    Jean-Marie Gothuey, Vincent Wietlisbach, Martin Rickenbach & Carlo la Vecchia

  2. Ufficio Medico Cantonale, Bellinzona

    Fabrizio Barazzoni

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  1. Jean-Marie Gothuey
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  2. Vincent Wietlisbach
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  3. Martin Rickenbach
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  4. Fabrizio Barazzoni
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  5. Carlo la Vecchia
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Gothuey, JM., Wietlisbach, V., Rickenbach, M. et al. Fréquence d'utilisation des différents traitements de l'infarctus du myocarde dans deux régions suisses. Soz Präventivmed 36, 333–340 (1991). https://doi.org/10.1007/BF01368741

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