Роль приверженности лечению в клиническом течении постинфарктного периода (по данным регистра острого инфаркта миокарда)

Aim. To evaluate the effects of long-term treatment adherence in the post-infarction period, taking into account the clinical and demographic data of patients and the prescribed drug therapies.Methods. A total of 115 patients who survived after myocardial infarction and recruited in the Acute Myocardial Infarction Registry were enrolled in the study. Patients were followed up for 5 years. Treatment adherence was evaluated with the Moriscos-Green scale. Obtained data were processed using the commercially available software Statistica 10.0 and SPSS Statistics Desktop 22.0.Results. Only 45% of patients who survived after myocardial infarction, strictly followed the recommendations of the attending physician regarding the prescribed drug therapy. The Kaplan-Mayer estimator reported that adherence to treatment in patients with myocardial infarction had a more significant role than the compliance of drug therapy with the existing guidelines. However, the mean values of the lipid profile did not reach the target levels regardless of patients’ adherence. In addition, one patient out of five who was strictly adhered to the medical recommendations did not reach the target levels of blood pressure.Conclusion. Adherence to treatment is an independent determinant of the effectiveness of secondary prevention of coronary artery disease. Failure to adhere medical recommendations by patients after myocardial infarction leads to a multiple increase in the likelihood of adverse cardiovascular events. However, failure to achieve the target lipid and blood pressure goals even in those patients who were strictly adhered to treatment may be associated with insufficient doses of drugs, thereby requiring particular attention and concern.Цель. Изучить влияние долгосрочной приверженности лечению на течение постинфарктного периода с учетом клинико-анамнестической характеристики пациентов, особенностей назначаемой медикаментозной терапии.Материалы и методы. В исследование включено 115 пациентов, выживших после перенесенного инфаркта миокарда и зарегистрированных в базе данных «Регистра острого инфаркта миокарда». Наблюдение за пациентами осуществлялось на протяжении 5 лет. Для определения степени приверженности лечению применялась шкала Мориски-Грина. Статистическая обработка результатов производилась с использованием программы Statisticav10.0 и демо-версии программы SPSSStatisticsDesktop, v22.0.Результаты. В результате проведенного исследования установлено, что только 45% пациентов, выживших после перенесенного инфаркта миокарда, строго соблюдали рекомендации лечащего врача относительно применяемой медикаментозной терапии. По результатам анализа кривых Каплана-Майера было установлено, что приверженность лечению у пациентов, перенесших инфаркт миокарда, в настоящем исследовании играла даже большую роль, чем соответствие медикаментозной терапии существующим рекомендациям. Однако средние значения показателей липидограммы не достигали целевых уровней не зависимо от степени приверженности. Кроме этого, каждый пятый пациент, строго соблюдавший врачебные рекомендации, не достигал целевых уровней артериального давления.Заключение. Приверженность лечению является независимым аспектом эффективности мероприятий вторичной профилактики ишемической болезни сердца. Несоблюдение врачебных рекомендаций пациентами, перенесшими инфаркт миокарда, приводит к кратному увеличению вероятности развития неблагоприятных сердечно-сосудистых событий в постинфарктном периоде. Вместе с тем, установленный факт отсутсвия достижения целевых значений липидограммы и уровня артериального давления в постинфарктном периоде даже у приверженных лечению пациентов обусловлен, по-видимому, назначением недостаточных доз медикаментозных препаратов, что также требует к себе повышенного внимания и коррекции

Difficulties of diagnostics of acute myocardial infarction in elderly and senile patients and their influence on management in the acute period of disease

Aim. To study the features of disease progress and approaches to the diagnostics of acute myocardial infarction (MI) among elderly and senile patients and their influence on the management in the acute period of disease.Materials and methods. The study was performed using the WHO program “Register of acute myocardial infarction” (Tomsk). The study included 410 patients (60 years and older), who had acute MI. The study group is represented by a comparable number of men (n=212) and women (n=198). The mean age of patients was 71 (66; 77) years (women are 5 years older than men (p<0,001)). Statistical processing was performed using the program Statistica V10.0.Results. Most of the patients had history comorbid pathology. In one in five patients (17,8%), the disease had an atypical manifestations, which in 41% of cases was represented by the asymptomatic form. Atypical manifestation of MI lengthened the prehospital phase of medical care due to a longer time before the first medical contact (p=0,005), as well as a late help-seeking (120 [49; 311,5] minutes). In 28% of patients, the level of creatine kinase-MB remained normal, and the indicator of troponin I exceeded the maximum values only in half of the cases. One fifth of the patients underwent acute MI treatment in non-core hospitals, which resulted in a low frequency of intervention (38%) and increasing by 2 times the chance of death within 5 years. The level of hospital mortality from acute MI in elderly patients in noncore hospitals was 3 times higher than in specialized departments (p<0,001).Conclusion. Difficulties in diagnostics of MI in patients of older age groups is caused by the prevalence of comorbid pathology, an atypical manifestations of the disease and low information content of biochemical markers of myocardial necrosis. It leads to an increase in time delays at the prehospital phase and frequent hospitalization of patients in non-core hospitals, making it impossible for them to receive timely, preferred therapy

Heart failure in Europe: Guideline-directed medical therapy use and decision making in chronic and acute, pre-existing and de novo, heart failure with reduced, mildly reduced, and preserved ejection fraction – the ESC EORP Heart Failure III Registry

Aims We analysed baseline characteristics and guideline-directed medical therapy (GDMT) use and decisions in theEuropean Society of Cardiology (ESC) Heart Failure (HF) III Registry. Methods and results Between1November 2018and31December 2020,10162 patients with acute HF (AHF, 39%, age 70 [62-79],36% women) or outpatient visit for HF (61%, age 66 [58-75], 33% women), with HF with reduced (HFrEF, 57%),mildly reduced (HFmrEF,17%) or preserved (HFpEF, 26%) ejection fraction were enrolled from 220 centres in 41European or ESC-affiliated countries. With AHF, 97% were hospitalized, 2.2% received intravenous treatment in theemergency department, and 0.9% received intravenous treatment in an outpatient clinic. AHF was seen by most bya general cardiologist (51%) and outpatient HF most by a HF specialist (48%). A majority had been hospitalized forHF before, but 26% of AHF and 6.1% of outpatient HF had de novo HF. Baseline use, initiation and discontinuation ofGDMT varied according to AHF versus outpatient HF, de novo versus pre-existing HF, and by ejection fraction. Afterthe AHF event or outpatient HF visit, use of any renin-angiotensin system inhibitor, angiotensin receptor-neprilysininhibitor, beta-blocker, mineralocorticoid receptor antagonist and loop diuretics was 89%, 29%, 92%, 78%, and 85%in HFrEF; 89%, 9.7%, 90%, 64%, and 81% in HFmrEF; and 77%, 3.1%, 80%, 48%, and 80% in HFpEF. ConclusionUse and initiation of GDMT was high in cardiology centres in Europe, compared to previous reports from cohortsand registries including more primary care and general medicine and regions more local or outside of Europe andESC-affiliated countries....................................

Cohort profile. the ESC-EORP chronic ischemic cardiovascular disease long-term (CICD LT) registry

The European Society of cardiology (ESC) EURObservational Research Programme (EORP) Chronic Ischemic Cardiovascular Disease registry Long Term (CICD) aims to study the clinical profile, treatment modalities and outcomes of patients diagnosed with CICD in a contemporary environment in order to assess whether these patients at high cardiovascular risk are treated according to ESC guidelines on prevention or on stable coronary disease and to determine mid and long term outcomes and their determinants in this population