PHARMACOEPIDEMIOLOGICAL ANALYSIS OF THE TREATMENT OF PAROXYSMAL AND PERSISTENT ATRIAL FIBRILLATION IN EVERY DAY CLINICAL PRACTICE

Aim. To analyze current clinical practice in the treatment of atrial fibrillation (AF) in emergency care department of multidisciplinary hospital in 2008-2009. Material and methods. Retrospective continuous pharmacoepidemiology study was carried out. Hospital history sheets of the patients admitted to the emergency care department in the period from 01.01.2008 to 31.12.2009 were analyzed. Results. Physicians of emergency care department mainly chose strategy of sinus rhythm restoration and maintenance in patients with paroxysmal and persistent AF . To implement this strategy pharmacological cardioversion was performed in patients with stable hemodynamics. The most frequently used medicine for pharmacological cardioversion was procainamide (60% of all prescriptions). Its efficacy was about 50% as compared with this of 80% for amiodarone and propafenone. In order to maintain sinus rhythm monotherapy with beta-blockers or amiodarone was preferred. Conclusion. Overall, AF treatment corresponded to current guidelines. Physicians preferred strategy of sinus rhythm restoration and maintenance

Фармакоэкономика как инструмент клинической фармакологии для оптимизации фармакотерапии (обзор)

Pharmacoeconomics is an essential component of health technology assessment and the appraisal of medicines for use by patients. As a comparatively young discipline, its methods continue to evolve. Pharmacoeconomic analysis encompass cost-minimization, cost-utility, cost-benefit, and cost-effectiveness studies, providing essential information critical for optimization of pharmacotherapy, optimal healthcare resource allocation and drug development success.Фармакоэкономика является важной составляющей в оценке медицинских технологий и экспертизы лекарственных средств для пациентов. Поскольку она является сравнительно молодой дисциплиной, ее методы продолжают развиваться. Фармакоэкономический анализ включает исследования «минимизации затрат», «затраты-эффективность», «затраты-утилитарность (полезность)» и «затраты-прибыль (польза)», предоставляя необходимую информацию, критическую для оптимизации фармакотерапии, оптимального размещения ресурсов здравоохранения и разработки новых лекарственных препаратов

Pharmacoeconomics as an instrument of clinical pharmacology for optimization of pharmacotherapy (review)

Pharmacoeconomics is an essential component of health technology assessment and the appraisal of medicines for use by patients. As a comparatively young discipline, its methods continue to evolve. Pharmacoeconomic analysis encompass cost-minimization, cost-utility, cost-benefit, and cost-effectiveness studies, providing essential information critical for optimization of pharmacotherapy, optimal healthcare resource allocation and drug development success

UP TO DAY POSSIBILITIES OF ATRIAL FIBRILLATION PREVENTION

Inhibitors of the renin-angiotensin-aldosterone system, statins, and possibly , ω-3 polyunsaturated fatty acids may influence the incidence of atrial fibrillation (AF), and can be used to prevent it. In recent medical literature, this approach is referred to as upstream treatment. The results of experiments and clinical studies show that the use of these drugs may be useful for AF primary prevention in certain categories of patients. Nevertheless, there are currently no sufficient evidences to justify these recommendations and apply them to a wider range of patients with AF risk factors. Thus, it is reasonable to continue studies on both primary and secondary AF prevention.</p

PHARMACOTHERAPY AND OUTCOMES OF ACUTE ST-ELEVATION MYOCARDIAL INFARCTION – GENDER DIFFERENCES IN REAL CLINICAL PRACTICE

Aim. To analyze gender differences in pharmacotherapy and outcomes of ST-elevation myocardial infarction (STEMI) in patients of cardiology hospital in real clinical practice. Material and methods. A continuous pharmacoepidemiological analysis was performed on the base of 153 records of patients with STEMI (men 102, women 51), consecutively admitted to the emergency department of cardiology hospital in the period from October 2010 to April 2011.Results. Women were on average 10.6 years older than men, had significantly higher incidence of severe comorbid conditions and significantly fewer prescribed medications improving STEMI prognosis - thrombolytics (21% vs 50%; p&lt;0.05), statins (20% vs 53%; p&lt;0.05), beta-blockers (84% vs 91%; p&lt;0.05) and dual antiplatelet therapy (21% vs 59%; p&lt;0.05). Hospital mortality was significantly higher in women than this in men, at that mortality differences persisted for 12 months after discharge.Conclusion. Older age, higher comorbidity rate, and lower treatment compliance with the current clinical recommendations in female STEMI patients in comparison with these in male STEMI patients contribute to higher hospital mortality and 12-month mortality after discharge in women with STEMI

RISK OF THROMBOEMBOLIC COMPLICATIONS AND ANTITHROMBOTIC THERAPY IN IN-PATIENTS WITH PERMANENT AND RECURRENT ATRIAL FIBRILLATION IN REAL CLINICAL PRACTICE

Aim. Тo evaluate compliance of ongoing antithrombotic therapy (ATT) in various forms of atrial fibrillation (AF) with the risk level of thromboembolic complications (TEC), calculated with the СHADS2 and CHA2DS2–VASc scales in real clinical practice. Material and methods. A retrospective study of hospital records of 308 in-patients admitted to the cardiology departments of two multidisciplinary hospitals during the year because of nonvalvular AF . Risk of thromboembolic complications was estimated with the CHADS2 and CHA2DS2–VASc scales and appointed ATT was analyzed. Results. Patients with high risk of TEC were predominated in the study population: 77.6% and 91.9% according to CHADS2 and CHA2DS2–VASc scales, respectively. Moderate risk was found in  17.6%  and  6.1%  of  patients  according  to  CHADS2 and  CHA2DS2–VASc  scales,  respectively.  Only  32.2%  and  28.6%  28.6%  of  patients  at  high  risk  according  to  CHADS2 and  CHA2DS2–VASc scales, respectively received warfarin in hospital. All patients with permanent AF in this sample had a high risk of TEC according to the both scales. In the group of paroxysmal/persistent AF the high, moderate and low risk of TEC was identified in 87%, 9.9%, and 3.1% of patients, respectively , according to CHA2DS2–VASc scale and in 64.25%, 28.5% and 7.5% of patients, respectively , according to CHADS2 scale. Difference in high-risk patient rate was not significant among patients with permanent AF . In high risk group contraindications for receiving indirect anticoagulants were more frequent in the group with permanent AF (OR 3.1; 95% CI 0.88–10.7; p&gt;0,05). The probability of warfarin prescription in patients with permanent AF was higher than in patients with paroxysmal or persistent AF (OR 1.98, 95% CI 1,18-3,31), and probability of aspirin prescription was lower (OR 0.82; 95% CI 0,51-1,32; p&gt;0,05).  Conclusion. In real clinical practice oral anticoagulants are prescribed insufficiently in patients at high risk. Usage of CHA2DS2–VASc scale compared with usage of CHADS2 scale, leads to significant increase in the proportion of patients at high risk due to reduction in the proportion of patients with moderate risk in persistent or permanent AF . Usage of CHADS2 scale can lead to an underestimation of the TEC risk in patients with persistent or permanent AF .</p