Detection and Treatment of Hyperuricemia in Clinical Practice (According to the PROFILE Outpatient Registry)

Aim. To study the frequency of detection of hyperuricemia (HU) in patients with high and very high cardiovascular risk and the frequency of prescribing drugs that lower serum uric acid (sUA) levels in real clinical practice.Material and methods: The general information of the study was based on the data of 2457 patients who were consistently included in the «PROFILE» registry until November 30, 2020: 1250 men (50.9%) and 1207 (49.1%) women. All patients with HU were selected (UA level ≥360 pmol/l in women, ≥420 pmol/l in men). At the stage of inclusion of the patient, data on MC indicators were available in 1777 (72.3%), upon re-examination - only 262 (33.2%) out of 790 patients who returned to the appointment.Results: The most common study of the level of sUA was performed in patients with gout (65.2%), with arterial hypertension (AH) and dyslipemia in 29.1% of cases, with diabetes mellitus (DM) - 30.1%, with impaired tolerance to glucose (IGT) - 40.2%, with other diseases, the proportion of patients with a known UA was even less. A positive relationship was found between the presence of AH and IGT with the frequency of UA control (p<0.001). In patients with AH, an increase in the level of sUA was detected significantly more often than in patients without AH (p<0.001), and less frequently in patients with DM and IGT (p<0.001 and p<0.01, respectively). The frequency of allopurinol prescribing was low: 49 (2%) patients received therapy, while of the 284 patients with HU, only 20 (7%) were prescribed allopurinol.Conclusion: in real clinical practice, only 29.1% of patients with AH and 20-25% of patients with other CVDs were monitored for sUA levels, every third patient had data on sUA levels at a repeat visit. In the presence of gout, the proportion of patients with current UA was higher (65%). For those with AH and IGT, positive correlations were found between the presence of the disease and control of sUA levels. A low frequency of prescribing drugs for the correction of HU was revealed

Challenges of Statin Therapy in Clinical Practice (According to Outpatient Register «PROFILE» Data)

Aim. To identify the main problems of statin therapy in patients with high and very high cardiovascular (CV) risk in real clinical practice.Material and methods. The general information of the study was based on data from 2,457 patients who were included in the register before November 30, 2020: 1,250 men (50.9%) and 1,207 (49.1%) women. A more detailed analysis was performed for groups of patients with high          and very high CV risk who had indications for statin treatment at the time of inclusion in the register: out of 2457 patients, 1166 people had very high CV risk, 395 was at high CV risk (a total of 1561 people, the average age of patients was 64.4±11.0 years).Results. Information on the parameters of the lipidogram – the level of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) was available in 1918 (78.1%) and 1546 (62.9%) patients, respectively. Of 1561 patients with high and very high CV risk, TC and LDL-C levels were analyzed in 1221 (78.2%) and 956 (61.2%) cases, statistically significantly more often in patients with high CV risk (p<0.05). Statins were recommended only to 823 (52.7%) patients with high and very high CV risk. Patients with very high CV risk received such appointments 4 times more often than patients with high CV risk: odds ratio (OR) 4.2; 95% confidence interval (CI) 3.2-5.3 (p<0.001). Doctors preferred atorvastatin in prescriptions (n=456, 55.4%), rosuvastatin (n=244, 29.7%) and simvastatin (n=121, 14.7%) were in second and third places. The target level of LDLC was 2 times more often achieved in patients with high CVR, compared with patients with very high CV risk: OR = 2.0, 95% CI 1.4-3.0 (p<0.001).Conclusion. The main problems of statin treatment in real clinical practice remain the non-assignment of these drugs to patients who have indications for such therapy and the failure to achieve the target levels of lipidogram indicators, which may probably be due to the clinical inertia of doctors regarding titration of statin doses, and in some cases caused by the choice of drugs that are not the most effective in reducing LDL cholesterol. Patients with very high CV risk are 4 times more likely to receive a recommendation to take statins compared to patients with high CV risk, but the target level of LDL cholesterol is reached in them 2 times less often

Assessment of adherence to medication and visits in healthcare facilities for cardiovascular patients who participated in international randomized controlled trials

Aim. To study the adherence to medication and visits in healthcare facilities and to assess some parameters of the treatment quality among patients who previously participated in randomized controlled trials (RCT).Material and methods. The TRUST (Influence of Participation in Randomized Controlled Trials on adheRence to Medicines’ Intake and regular viSits to the docTor) study included patients from the outpatient register PROFILE. The main group included patients, who from 2011 to 2018 at different times participated in one or more of the 16 international RCT — 102 patients: 53 women (52%) and 49 men (48%). The mean age of patients was 71±10 years. These 16 RCTs included patients with different cardiovascular diseases and risk factors. Personal or telephone contact was established with patients or their relatives from March to June 2019. The vital status of 88 patients was determined: 9 patients died (phone contact with relatives), 77 patients answered to questionnaires, 2 persons declined to participate in the survey.Results. 59 patients (76,6%) visit a cardiologist at least once every 6 months, and 6 patients (7,8%) visit a cardiologist once a month. Patients who participated in RCT had high adherence rates. Thus, 33 patients (42,9%) showed high adherence, 34 patients (44,1%) — average and only 10 patients (13%) — low. Among patients with coronary artery disease, significantly higher adherence to drug therapy was observed: 25 of 48 patients (51,2%) demonstrated high adherence (p=0,015). Similar values were demonstrated in the group of diabetes patients — high adherence was observed in 17 (60,7%) of 28 patients (p=0,015). Among patients with heart rate disturbances high adherence was observed in 13 (72,2%) of 18 patients (p=0,09).Conclusion. Preliminary results of the TRUST study confirm that previous patient involvement in RCTs has a positive effect on subsequent treatment adherence after RCT

Factors associated with in-hospital mortality in patients after acute cerebrovascular accident (according to the REGION-M register)

Aim. To determine the main factors associated with in-hospital mortality in patients after acute cerebrovascular accident based on the medical history data.Material and methods. The study used the data of retrospective hospital part of the REGION-M register, which included all patients hospitalized in one Moscow city clinical hospital from January 1, 2012 to March 30, 2017 with stroke and transient ischemic attack. We analyzed the presence of following parameters’ information in case histories of patients who died in hospital and those who were discharged: risk factors (RF), socio-demographic factors, history of cardiovascular and concomitant diseases. The association of factors recorded at hospital admission with mortality rate was studied, and multivariate logistic regression was constructed. A combination of factors significantly associated with in-hospital mortality was determined.Results. Of 900 patients (365 (40,6%) men and 535 (59,4%) women) included in the REGION-M register, 216 (24,0%) died in the hospital. Assessment of the RF information presence showed that the smoking data was disclosed in 54,3% of case histories, family history — 1,1%, education level — 8,6%, alcohol consumption — 7,4%, disability — 79,1%, hypercholesterolemia — 6,4%. However, there were no significant differences on the completeness of the data collection on the listed RF between deceased and discharged patients. Factors such as gender, age, and outcome were described in all case histories. Univariate analysis of factors significantly associated with patients’ mortality marked out age and history of cardiovascular diseases (coronary artery disease (CAD), atrial fibrillation (AF), venous thrombosis) and/or concomitant diseases (diabetes, anemia). Multivariate logistic regression identified factors associated with increased in-hospital mortality as follows: CAD, AF, diabetes, venous thrombosis.Conclusion. Hospital-based physicians pay little attention to the recording of cardiovascular RF and sociodemographic parameters in patients with stroke, regardless of the condition severity and outcome. In-hospital mortality is associated with age, CAD, AF, diabetes, and venous thrombosis.Region-M register workgroup: Akimova A. V., Arutyunov G. P., Belova E. N., Blagodatskikh S. V., BoytsovS. A., Budaeva I. V., Vernokhae-va A. N., ViskovR. V., Voronina V. P., GladilkinaM. P., DeevA. D., Dmitrieva N. A., Drapkina O. M., Zagrebelny A.V., Kvitivadze G. K., Kudryashov E. N.., Kokareva I. V., Kudryashov E. V., Kutishenko N. P., Lerman O. V., Lukina Yu. V., LukyanovM. M., Martsevich S. Yu., Matveeva A. D., Matske-vich L. A., Mitichkin A. E., Nikitina G. I., Nekoshnova E. S., OvsepyanM. A., Okshina E. Yu., PalamarchukV. N., Parsadanyan N. E., PorezanovaM. V., Stakhovskaya L. V., Stolboushkina E. A., Hapaeva M. A., Chernyshova M. I., Shamalov N. A