The Study of Adherence to Drug Therapy at the Stage of Outpatient Follow-up in Patients with Acute Myocardial Infarction (Data from the PROFIL-IM Registry)

Aim. To assess adherence  to the recommended therapy at the stage of outpatient follow-up and its impact on long-term outcomes  in patients after acute myocardial  infarction based on the materials of the prospective PROFILE-IM registry.Material and methods. The PROFILE-IM register included 160 patients who applied to one of the polyclinics in Moscow after a myocardial  infarction. The combined endpoint (CE) included death from any cause, cardiovascular events (nonfatal myocardial infarction,  nonfatal cerebral stroke), emergency hospitalizations for cardiovascular diseases, significant  cardiac arrhythmias. Patients' adherence to therapy was assessed using the original questionnaire "Scale of Adherence of the National Society of Evidence-based Pharmacotherapy" (NODF) and a direct standardized patient survey by a doctor about taking medications. Visits to the doctor were carried out every two months,  data from the first year of patient follow-up are presented.Results. In a personal  interview  with a doctor,  the ratio of the proportion  of committed, partially  committed  and non-committed patients  did not change  significantly over the entire follow-up period, while the proportion of committed patients was 81-85%. The "NODF Adherence Scale" showed that the proportion of non-committed patients was about 10 times higher than with direct patient responses to the doctor, and the proportion of non-committed  and partially committed  patients remained high at all stages of follow-up (respectively 28% and 10% at the beginning of the study, 18% and 10% at the end of the study).  Among the main factors  of non-commitment, there was a decrease  in the importance  of forgetfulness and an increase  in factors  such  as fear  of side effects  of medications, doubt  about  the need  for long-term use of medications  and  well-being. A  direct relationship of adherence with the male sex, the presence of hypertension, a feedback  relationship with alcohol consumption was revealed. The risk of CE in non-committed patients was higher compared  to the group of committed  and partially committed  patients (p<0.01).Conclusion. The proportion of non-committed and partially committed patients remained high at all stages of follow-up. There was a direct relationship between adherence to therapy with the male sex, the presence of hypertension in the anamnesis, and a feedback relationship with alcohol consumption. Low adherence to therapy significantly increased the risk of cardiovascular events

Outpatient Register of Patients with Acute Myocardial Infarction: Assessment of the Hypertension Impact on Long-term Prognosis

Aim. To assess the impact of arterial hypertension (AH) on the long-term outcomes in patients after acute myocardial infarction (AMI).Material and methods. 160 patients were included: 106 (66.2%) men and 54 (33.8%) women, average age 74.2±11.2 years, discharged from Moscow hospitals with a diagnosis of AMI (from March 01, 2014 till June 30, 2015) and applied to the city polyclinic №9 in Moscow or its branches for outpatient observation. The information was obtained on the basis of medical documentation of the polyclinic and data of patients’ examination/questioning by phone, conducted every 2 months. The follow-up duration was 1 year, the incidence of cardiovascular complications (CVC) was estimated: death, nonfatal AMI, nonfatal cerebral stroke, new cases of atrial fibrillation (AF), hospitalization for unstable angina, hypertensive crisis, heart failure, unplanned surgical interventions on the heart and blood vessels.Results. AH before the development of reference AMI was observed in 118 (73.4%) patients: 48 women and 70 men; in women, AH was recorded more often than in men: 88.9% and 66.0%, respectively, p<0.05. Patients with AH were older than patients without AH: 63.0 (54.0; 74.0) and 55.5 (49.0; 61.0) years, respectively, p<0.001, among them there were more retirees 76 (64.4%) and patients with disabilities 45 (38.1%), p<0.05. Patients with AH compared with patients without AH were less likely to smoke (18.6% and 38.1%, respectively) and drank alcohol (30.5% and 52.4%, respectively), p<0.05 for both; more likely to visit the outpatient clinic (89.0% and 66.7%, respectively), p<0.05. There were no significant differences between the groups of patients with and without AH in the history of cerebral stroke, AMI, arrhythmia by AF type, diabetes mellitus and obesity, except for angina of tension (18.6% and 2.4%, respectively) and hypercholesterolemia (37.3% and 11.9%, respectively), p<0.05 for both. Despite the fact that patients with AH were significantly more often prescribed antihypertensive, lipid-lowering and antithrombotic drugs before reference AMI, the frequency of their use was low: renin-angiotensin-aldosterone system blockers were prescribed in 70 (59.3%) patients, beta-blockers – in 35 (29.7%), calcium antagonists – in 20 (16.9%), diuretics – in 13(11.0%), antiplatelet agents – in 39 (33.1%), statins – in 9 (7.6%) patients. After one year of follow-up, CVC was registered in 33 (28.0%) patients with AH and 9 (21.4%) patients without AH (p=0.41). There was no statistically significant effect of AH on long-term outcomes of AMI, adjusted risk ratio =1.30 [95% confidence interval 0.68- 2.49], p>0.05. The effect of AH on the development of CVC, estimated using the Kaplan-Mayer curve, was not statistically significant (p=0.120).Conclusion. During 1 year of follow-up after AMI in patients with AH the frequency of CVC – death, nonfatal AMI, nonfatal cerebral stroke, new cases of AF, hospitalization for unstable angina, hypertensive crisis, heart failure – did not exceed the overall frequency of CVC in patients without AH

HEREDITARY TROMBOPHILIA AND ISCHEMIC STROKE IN YOUNG ADULTS

In this article the most widespread hereditary trombophilia in the setting of ischemic stroke etiology in young patients is considered. Own data on prevalence of various options of hereditary trombophilia in 188 patients who were treated in neurologic department for patients with acute disorders of cerebral blood circulation in Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1 are provided

Untapped Possibilities of Antiischemic Therapy after Acute Myocardial Infarction: Data from the PROFILE-IM Register

Aim. To evaluate the practice of prescribing antianginal/antiischemic therapy in patients who, after acute myocardial infarction (AMI), retained typical clinical manifestations of stable angina.Material and methods. The registry includes 160 patients who applied to the polyclinic from March 01, 2014 to June 30, 2015 after suffering an AMI. Anti-ischemic therapy was evaluated in patients with typical angina pectoris.Results. Based on the survey, typical angina attacks were detected in almost a quarter of patients (38 patients – 23.8%). According to the main indicators, patients with typical angina pectoris practically did not differ from the rest of the group of patients, with the exception of a significantly larger proportion of patients with diagnosed ischemic heart disease before AMI and patients under dispensary supervision. Almost all patients received beta-blockers (97.4%), about a third of patients received calcium antagonists (28.9%) or long-acting nitrates (34,2%). During the first year after AMI, second-line drugs were practically not prescribed to enhance antianginal therapy. According to international non-proprietary names, the choice of doctors tended to prescribe bisoprolol, amlodipine, and isosorbide dinitrate. Exacerbation of the disease course with hospitalization for unstable angina pectoris was recorded in 9 (23.7%) patients from the group with typical angina pectoris and in 5 (4.1%) patients in the rest of the group (p<0.001).Conclusion. In real clinical practice, only a small part of patients with typical angina pectoris receive drug therapy that corresponds to evidence-based medicine; therefore, the unique possibilities of antianginal (anti-ischemic) therapy often remain unrealized

PROSPECTIVE OUTPATIENT REGISTRY OF MYOCARDIAL INFARCTION PATIENTS (PROFILE-MI): STUDY DESIGN AND FIRST RESULTS

Aim. To characterize patients included to the registry PROFILE-MI; to present data reflecting the condition of patients before the onset of acute myocardial infarction (MI).Material and methods. Totally, 160 patients included: 106 males, 54 females — 66,2%/33,8%, respectively, consequently visited cardiologist in the City Polyclinics №9 of Moscow or one of two its branches, after hospitalization for MI.Results. Mean age of patients 70,4±10,8 (39-87) y.o., males were in average 10 years younger than women. About 40% were >60 y.o., about a half were retired, and of those most were women, ~1/3 of patients were already disabled; in ~3/4 there was arterial hypertension. For smoking and lipid disorders, in most patients there was no data: only for 29,4 and 46,9%, respectively; diabetes was found in 28,1%. Anamnesis of coronary heart disease (CHD) had been registered in anamnesis of 47 (29.4%), and most of those already experienced myocardial infarction (MI). Half of the included patients had had visited medical institutions during 2 year period before the MI event, most of them — local outpatient institutions (polyclinics), but 1/3 of patients did not request for medical help during last ≥2 years.Conclusion. Patients included to PROFILE-MI registry, had in general similar demographic and clinical parameters with other registries of MI in Russia. Most post MI patients already had cardiovascular diseases of atherosclerotic origin, or a combination of traditional CHD risk factors, so MI onset was quite predictable. Most of them were not under the coverage of primary and secondary CHD preventions before MI event

Assessment of the Adequacy of Drug Choice in Patients with Acute Myocardial Infarction According to the PROFILE-IM Registry

Background. The prognosis for patients after acute myocardial infarction (AMI) can be improved by prescribing beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEI) and statins. This is reflected in the current clinical guidelines, in which these drugs are considered mandatory for almost all patients after AMI. However, not all representatives of the same drug class have the same evidence base in relation to the impact on the outcomes of AMI, in addition, not all BB and ACEI, according to the official instructions have the indication "recent AMI".Aim. To assess the adequacy of the choice of BB, ACEI and angiotensin receptor antagonists (ARA), prescribed after recent AMI, using the materials of the prospective registry PROFILE-IM.Material and methods. 1 60 patients after AMI referred to outpatient clinic from March 01,2014 to June 30, 201 5 were included into the registry. The therapy prescribed to patients at discharge from the hospital and at the first visit to the outpatient clinic were evaluated, special attention was paid to three classes of drugs: BB, ACEI/ARA.Results. The majority of patients were recommended ACEI/ARA (88.1%) and BB (98.8%) at discharge from hospital. Not prescribing of these groups of drugs in about half of the cases had a reasonable cause, for ACEI/ARA in 13 patients (8.1%) the cause could not be clarified. When choosing a BB in most cases (both in hospital and in the outpatient clinic) preference was given to bisprolol (61% and 67%, respectively), which has no evidence of prognosis improvement for patients after AMI, the second place took metoprolol, its prescription was two times less than bisprolol. When choosing ACEI, priority was given to perindopril, with which no one randomized clinical trial was carried out in patients after AMI (38% of prescriptions in the hospital and 41% - in the outpatient clinic). Enalapril took the second place (20% and 22%, respectively), the remaining ACEI were prescribed much less frequently, ARA were also prescribed rarely (5%).Conclusion. After AMI the majority of patients were prescribed BB, ACEI/ARA, which in accordance with current clinical guidelines are necessary to improve long-term outcomes. However, the choice of a specific drug within the drug class not always consistent with evidence-based medicine, current clinical guidelines and the official instructions for the medical use. In this regard, patients after AMI do not receive all the benefits of drug therapy to improve long-term outcomes

OUTPATIENT REGISTRY OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION (PROFILE-IM): DATA ON PREHOSPITAL THERAPY IN COMPARISON WITH THE LIS-3 REGISTRY

Aim. To study the quality of prehospital therapy in patients with a history of acute coronary syndrome/acute myocardial infarction (ACS/AMI), and included in 2 registers: LIS-3 and PROFILE-IM.Material and methods. Data on therapy before the reference ACS in the hospital register LIS-3 (Lyubertsy town, 01.11.2013-31.07.2015) and in the AMI outpatient registry PROFILE-IM (Moscow city polyclinic N9) were compared. Anonymized data from the case histories (320 patients from the LIS-3 registry) and outpatient charts (160 patients from the PROFILE-IM register) were analyzed.Results. Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers before AMI in patients from PROFILE-MI were prescribed significantly more often than in the LIS-3 registry (49.4% vs 39.4%, respectively, p<0.05), as well as calcium channel blockers – 6.7% vs 5.3%, respectively (p<0.05). The frequency of prescription of statins, antiplatelet agents and anticoagulants before reference AMI in patients of both registers did not differ significantly. Assessment of adherence to treatment was performed in the PROFILE-IM registry. 56 (35.0%) patients did not take medication. Among cases with pharmacotherapy only 41 (39.4%) patients had regular taking, and 24 (23.1%) took medication in worsening health, 39 (37.5%) had only short medication courses. Similar data were revealed in patients already having ischemic heart disease.Conclusion. Primary and secondary drug prevention of AMI in both registries did not meet modern clinical guidelines. This was especially true for patients with already established ischemic heart disease and to the greatest extent, according to both registries, refers to drugs from the statin group

Effect of Previous Cardiovascular Diseases on Long-Term Outcomes of Acute Myocardial Infarction: Data of the Outpatient Registry "PROFILE-IM”

Aim. Within the framework of the outpatient registry of patients with acute myocardial infarction (AMI), to assess the influence of factors in medical history, especially cardiovascular diseases (CVD) preceding AMI, on the long-term results of the underlying disease.Material and methods. 160 patients who  sought medical care to the outpatient clinic from March  01,  2014 to June 30,  2015 after  AMI were included into the registry. Patients were observed for at least 1 year (maximum 2.5 years). The primary end point (PEP) of the study were death from any cause,  recurrent cardiovascular complications (non-fatal AMI, cerebral stroke), and urgent hospitalization due to the worsening of the current CVD.Results. After 1 year of follow-up, 9 (6%) patients died (8 from CVD). A recurrent myocardial infarction occurred in 8 patients, and cerebral stroke in 1 patient. 20 patients were hospitalized due to CVD exacerbation. In total PEP was registered in a fifth part of patients (36 people). Factors that had a negative impact on the endpoint were age (relative risk [RR] 1,05; 95% confidence interval [CI] 1.01-1.09, p=0.016), the presence of cardiovascular diseases or conditions reflecting the severity of the underlying disease before the reference event: ischemic heart disease (RR 2.37; 95%CI 1.05-5.34, p=0.038), previously AMI (RR=5.93; 95%CI 2.28-15.4, p<0.001), percutaneous coronary intervention (RR 9.84; 95%CI 2.02-48.06, p<0.005), disability (RR 4.37; 95%CI 1.82-10.46, p<0.001).Conclusion. The long-term life and  disease prognosis in patients with AMI remains quite severe.  Adverse long-term outcomes of the  disease are largely determined by anamnestic factors, primarily the  presence of ischemic heart  disease before  the  reference event,  previous AMI. The study indirectly demonstrated that percutaneous coronary intervention in patients with stable ischemic heart disease, at least, does not improve the prognosis of the disease

The Main Cardiovascular Complications and Mortality Rates During the First One and a Half Years after Acute Myocardial Infarction: Data from the Prospective Outpatient Registry PROFILE-IM

Aim. To study the long-term outcomes of patients who survived after acute myocardial infarction (AMI) in a prospective outpatient registry.Material and methods. Patients (n=160) who applied to one of the outpatient clinics in Moscow after AMI were included in the registry PROFILE-MI. The total follow-up period was 1.5 years. The primary combined endpoint (PCE) included death from any cause, cardiovascular events (nonfatal myocardial infarction, nonfatal cerebral stroke), emergency hospitalizations for cardiovascular diseases, significant cardiac arrhythmias. 1-year observation period was taken in analysis of the factors affecting the development of PCE.Results. During the observation period, 16 patients (10%) died. Life status was not obtained in 4 patients. Most of the deaths were due to cardiovascular complications; in a quarter of patients, repeated AMI was the cause of death. After 12 months of follow-up, the development of PCE was observed in 42 patients. PCE has been identified more often in elderly patients, in patients who had certain complications in the acute period of AMI, in patients who had swelling at the time of the examination in the outpatient clinic, who complained of shortness of breath, and also had a heart rate (HR) more than 70 min-1. Normal blood pressure (within 120/80-139/89 mm Hg) and HR at 60-70 min-1 had a positive prognostic influence. Conclusion. Despite intensive treatment in a hospital and the relatively high quality of secondary pharmacological prevention, the prognosis of life and disease in patients after AMI remains quite serious