Сравнение особенностей медикаментозной вторичной профилактики сердечно-сосудистых заболеваний у пациентов, перенесших инфаркт миокарда, в амбулаторных условиях за 2001-2006 гг. (фармакоэпидемиологическое исследование)

The two-stage retrospective review of 1375 medical records of ambulatory patients with myocardial infarction was carried out in order to assess the delivery rate of up-to-date international and domestic guidelines for secondary CVD prevention over a period of 2001- 2006. The gap between the current guidelines for medicamental prophylaxis and their implementation in clinical outpatient practice was revealed. In spite of the fact that doctors began to prescribe preventive drugs more often target levels for cholesterol and blood pressure were not achieved in the major part of patients with myocardial infarction. The prescription rate of antiaggregants, anticoagulants and statins is still rather low.Проведен двухэтапный ретроспективный анализ амбулаторных карт 1375 пациентов кардиологического диспансера, перенесших инфаркт миокарда, на предмет выполнения международных и отечественных рекомендаций по медикаментозной вторичной профилактике ССЗ за период 2001-2006 гг. На этапе амбулаторного лечения выявлено несоответствие между существующими стандартами медикаментозной профилактики и их реализацией в клинической практике. Несмотря на то, что основные группы лекарственных препаратов стали назначаться достоверно чаще, больше чем у половины больных не были достигнуты целевые уровни показателей липидного профиля и артериального давления. В недостаточной мере продолжают применяться в амбулаторных условиях антиагреганты, антикоагулянты и статины

Five-Year dynamics of secondary prevention in patients with stable angina at specialized out-patient level in Moscow (Pharmacoepidemiology Study)

Aim. To assess five-year trend in terms of specialists' adherence to guidelines on secondary prevention of cardiovascular diseases in patients with stable angina on the level of out-patient specialized healthcare institution in Moscow. Material and methods. Two-stage retrospective pharmacoepidemiological study was conducted. The object of the study - patient medical records. At the first stage of the study medical records of 2915 patients with stable angina visited the healthcare institution for the first time in 2006 were included; at the second stage - medical records of 1633 patients with stable angina with primary visit in 2011. Results. Over the five-year period prescription rates of drugs improving prognosis in patients with stable angina significantly increased: antiplatelets - up to 82.7%, beta-blockers - up to 74.3%, statins - up to 45.6%. Despite of no changes registered in prescription rate of the ACE inhibitors, marked increase up to 14.7% in prescription rate of angiotensin receptor blockers was revealed. In the prescription structure of pharmacological groups changes were detected concerning the preferred choice of a specific drug. Due to implementation of dual antiplatelet therapy into clinical practice a reduced number of recommendations of acetylsalicylic acid as monotherapy (down to 93.0%) and increased - in combination with clopidogrel (up to 5.4%) was registered at the second stage of the study. Over a five-year period bisoprolol (55.0%) occupied the leading position in the group of beta-blockers. Metoprolol's prescription rate decreased to 27.4%. Prescription rate of atenolol decreased down to 3.1%, while that of nebivolol increased up to 8.3%. When choosing among statins specialists recommended significantly more often atorvastatin (up to 52.9%). In the group of ACE inhibitors three drugs preserved their leading positions. Meanwhile the number of recommendations of enalapril increased up to 50.8%, perindopril - up to 24.1%. Analysis of prescribed doses revealed significant increase in recommendations of specific drugs in higher daily doses: acetylsalicylic acid 100 mg - up to 71.1%, simvastatin and atorvastatin 20 mg - up to 60.5% and 41.9%, respectively. When prescribing beta-blockers and ACE inhibitors specialists continued to use minimal and medium therapeutic doses, possibly due to dose titration in patients with comorbidities. Conclusion. Study results demonstrated positive trend in terms of specialists' adherence to guidelines on secondary prevention of cardiovascular diseases in patients with stable angina. However, a number of problem aspects were identified that require further optimization of medical and preventive measures in healthcare institutions. © 2018, Stolichnaya Izdatelskaya Kompaniya

Secondary prevention in patients after myocardial infarction at ambulatory specialized cardiology institution (pharmacoepidemiology study)

Aim. To assess 5 years trend in level of doctor's adherence to actual guidelines on secondary prevention of cardiovascular diseases in patients with a history of myocardial infarction in ambulatory specialized healthcare institution in Moscow. Material and methods. There were 752 patients firstly visited healthcare institution in 2006 and 825 patients - in 2011. Their data was included in two-stage retrospective pharmacoepidemiology study. Results. Prescription rate significantly increased for three of four prophylactic groups recommended for patients with a history of myocardial infarction (antiplatelets - 91.76%, beta-blockers - 83.39%, statins - 69.45%). When assessing prescribed doses of drugs, an increase in a number of their higher doses prescriptions was revealed (at the second stage of the study acetylsalicylic acid 100 mg/day received 75.32% of patients, enalapril 20 mg/day - 30.45%, simvastatin and atorvastatin 20 mg/day - 64.52% and 47.89% of patients, respectively). Conclusion. Results showed growing level of doctor's adherence to actual recommendations on therapy and secondary prevention of cardiovascular diseases. Nevertheless, the level of adherence remains unsatisfactory and requires additional work with doctors

Secondary prevention of cardiovascular diseases among patients of different age groups with a history of myocardial infarction by the example of outpatient cardiology institution

Aim. To study secondary prevention of cardiovascular diseases among patients of different age groups with a history of myocardial infarction by the example of outpatient cardiology institution. Material and methods. Retrospective pharmacoepidemiological study was conducted by analyzing the medical records of 825 patients with a history of myocardial infarction, who visited the outpatient cardiology institution for the first time in 2011. Patients were divided into two groups according to their age: younger than 60 years (n=308), and 60 years and older (n=517). Results. The population of elderly patients was more severe: significantly more often patients had disability and co-morbidities. The prevalence of the main modifiable risk factors could not be assessed fully due to the lack of information in patients' medical records. Elderly patients were significantly less likely to receive β-blockers (80.3%) and statins (63.8%). No significant differences were found in daily doses of the main prescribed preventive drugs between two groups. Conclusion. Secondary prevention of cardiovascular diseases among patients of different age groups could not be considered proper, as there is low level of attention to the modifiable risk factors and recommendation on their correction. A tendency to under-prescription of angiotensin converting enzyme inhibitors was revealed, as well as significantly lower number of recommendations for taking statins and β-adrenoblockers in the group of elderly patients

Drug interchangeability: Clinical efficacy and safety

The paper deals with the problem of the interchangeability of brand-name and generic drugs. Touching upon official terminology and the normative documents that govern the registration of generics in Russia and foreign countries, the authors state that there is no concerted approach to estimating drug interchangeability, indicate that there are some disadvantages of using a method for proving the bioequivalence of the compared drugs as evidence for their therapeutic equivalence, and point out that Russia's legal regulation of drug circulation lacks attention to the proper use of generics. The problem of interchangeability is particularly acute when prescribing narrow therapeutic range drugs, including anticonvulsant drugs. The results of the investigations discussed in the article demonstrate the need for a very cautious approach to using generic drugs in the therapy of epilepsy due to the fact that the disease may worsen. The authors come to the conclusion that treatment with less expensive generic drugs is far from always more economical. The change from a brand-name for a generic drug should be carefully approached, basing on the data of properly designed and conducted studies of therapeutic equivalence

Drug interchangeability: Clinical efficacy and safety

The paper deals with the problem of the interchangeability of brand-name and generic drugs. Touching upon official terminology and the normative documents that govern the registration of generics in Russia and foreign countries, the authors state that there is no concerted approach to estimating drug interchangeability, indicate that there are some disadvantages of using a method for proving the bioequivalence of the compared drugs as evidence for their therapeutic equivalence, and point out that Russia's legal regulation of drug circulation lacks attention to the proper use of generics. The problem of interchangeability is particularly acute when prescribing narrow therapeutic range drugs, including anticonvulsant drugs. The results of the investigations discussed in the article demonstrate the need for a very cautious approach to using generic drugs in the therapy of epilepsy due to the fact that the disease may worsen. The authors come to the conclusion that treatment with less expensive generic drugs is far from always more economical. The change from a brand-name for a generic drug should be carefully approached, basing on the data of properly designed and conducted studies of therapeutic equivalence

Five-Year dynamics of secondary prevention in patients with stable angina at specialized out-patient level in Moscow (Pharmacoepidemiology Study)

Aim. To assess five-year trend in terms of specialists' adherence to guidelines on secondary prevention of cardiovascular diseases in patients with stable angina on the level of out-patient specialized healthcare institution in Moscow. Material and methods. Two-stage retrospective pharmacoepidemiological study was conducted. The object of the study - patient medical records. At the first stage of the study medical records of 2915 patients with stable angina visited the healthcare institution for the first time in 2006 were included; at the second stage - medical records of 1633 patients with stable angina with primary visit in 2011. Results. Over the five-year period prescription rates of drugs improving prognosis in patients with stable angina significantly increased: antiplatelets - up to 82.7%, beta-blockers - up to 74.3%, statins - up to 45.6%. Despite of no changes registered in prescription rate of the ACE inhibitors, marked increase up to 14.7% in prescription rate of angiotensin receptor blockers was revealed. In the prescription structure of pharmacological groups changes were detected concerning the preferred choice of a specific drug. Due to implementation of dual antiplatelet therapy into clinical practice a reduced number of recommendations of acetylsalicylic acid as monotherapy (down to 93.0%) and increased - in combination with clopidogrel (up to 5.4%) was registered at the second stage of the study. Over a five-year period bisoprolol (55.0%) occupied the leading position in the group of beta-blockers. Metoprolol's prescription rate decreased to 27.4%. Prescription rate of atenolol decreased down to 3.1%, while that of nebivolol increased up to 8.3%. When choosing among statins specialists recommended significantly more often atorvastatin (up to 52.9%). In the group of ACE inhibitors three drugs preserved their leading positions. Meanwhile the number of recommendations of enalapril increased up to 50.8%, perindopril - up to 24.1%. Analysis of prescribed doses revealed significant increase in recommendations of specific drugs in higher daily doses: acetylsalicylic acid 100 mg - up to 71.1%, simvastatin and atorvastatin 20 mg - up to 60.5% and 41.9%, respectively. When prescribing beta-blockers and ACE inhibitors specialists continued to use minimal and medium therapeutic doses, possibly due to dose titration in patients with comorbidities. Conclusion. Study results demonstrated positive trend in terms of specialists' adherence to guidelines on secondary prevention of cardiovascular diseases in patients with stable angina. However, a number of problem aspects were identified that require further optimization of medical and preventive measures in healthcare institutions. © 2018, Stolichnaya Izdatelskaya Kompaniya

Secondary prevention of cardiovascular diseases among patients of different age groups with a history of myocardial infarction by the example of outpatient cardiology institution

Aim. To study secondary prevention of cardiovascular diseases among patients of different age groups with a history of myocardial infarction by the example of outpatient cardiology institution. Material and methods. Retrospective pharmacoepidemiological study was conducted by analyzing the medical records of 825 patients with a history of myocardial infarction, who visited the outpatient cardiology institution for the first time in 2011. Patients were divided into two groups according to their age: younger than 60 years (n=308), and 60 years and older (n=517). Results. The population of elderly patients was more severe: significantly more often patients had disability and co-morbidities. The prevalence of the main modifiable risk factors could not be assessed fully due to the lack of information in patients' medical records. Elderly patients were significantly less likely to receive β-blockers (80.3%) and statins (63.8%). No significant differences were found in daily doses of the main prescribed preventive drugs between two groups. Conclusion. Secondary prevention of cardiovascular diseases among patients of different age groups could not be considered proper, as there is low level of attention to the modifiable risk factors and recommendation on their correction. A tendency to under-prescription of angiotensin converting enzyme inhibitors was revealed, as well as significantly lower number of recommendations for taking statins and β-adrenoblockers in the group of elderly patients

Secondary prevention in patients after myocardial infarction at ambulatory specialized cardiology institution (pharmacoepidemiology study)

Aim. To assess 5 years trend in level of doctor's adherence to actual guidelines on secondary prevention of cardiovascular diseases in patients with a history of myocardial infarction in ambulatory specialized healthcare institution in Moscow. Material and methods. There were 752 patients firstly visited healthcare institution in 2006 and 825 patients - in 2011. Their data was included in two-stage retrospective pharmacoepidemiology study. Results. Prescription rate significantly increased for three of four prophylactic groups recommended for patients with a history of myocardial infarction (antiplatelets - 91.76%, beta-blockers - 83.39%, statins - 69.45%). When assessing prescribed doses of drugs, an increase in a number of their higher doses prescriptions was revealed (at the second stage of the study acetylsalicylic acid 100 mg/day received 75.32% of patients, enalapril 20 mg/day - 30.45%, simvastatin and atorvastatin 20 mg/day - 64.52% and 47.89% of patients, respectively). Conclusion. Results showed growing level of doctor's adherence to actual recommendations on therapy and secondary prevention of cardiovascular diseases. Nevertheless, the level of adherence remains unsatisfactory and requires additional work with doctors

Analysis of changes in pharmacotherapy of stable angina over the five-year period at specialized out-patient level of medical care (pharmacoepidemiological study)

Introduction: Ischemic heart disease (IHD) remains the leading cause of death both in Europe and in Russia. The most common form of IHD is stable angina. There is compelling evidence that strict adherence to clinical guidelines greatly contributes to mortality reduction. However, the gap between modern knowledge and use of guideline-recommended medications remains significant. As shown by Western practice, one of the possible solutions of this problem is regular conduction of pharmacoepidemiological studies. Objective: Investigate the dynamics of drug prescription rates in patients with stable angina over the five-year period on the example of routine clinical practice of outpatient cardiology institution of Moscow for the purpose of further eliminating the prescribing gap for guideline recommended pharmacological strategies. Materials and methods: Our research work was performed as a retrospective pharmacoepidemiological study including two stages with five-year interval using cross-section method. Results and discussion: We found a significant increase in use of antiplatelets (82.7 vs. 56.2%, p<0.05) and statins (45.6 vs. 16.1%, p<0.05). Despite the unchanged use of ACE inhibitors, the prescription rate of angiotensin receptor blockers II increased (14.7 vs. 9.7%, p<0.05). Analysis of anti-ischemic pharmacotherapy revealed an increase in beta-adrenoblockers use (74.3 vs. 63.6%, р<0.05) and a decrease in use of long-acting nitrates (26.3 vs. 31.1%, р<0.05) and calcium channel blockers (35.7 vs. 39.6%, р<0.05). Significant changes were found in prescription rates and dosage regimens of single medications in each pharmacological group. The study results demonstrated an increase in frequency of capturing data on lipid profile and diet recommendations in patient records. Conclusion: Such type of pharmacoepidemiological study carried out for the first time made it possible to investigate the dynamics of specialists' adherence to guidelines of stable angina pharmacotherapy in routine outpatient clinical practice