27 research outputs found
Π‘ΡΠ°Π²Π½Π΅Π½ΠΈΠ΅ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠ΅ΠΉ ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½ΡΠΎΠ·Π½ΠΎΠΉ Π²ΡΠΎΡΠΈΡΠ½ΠΎΠΉ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΡΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΏΠ΅ΡΠ΅Π½Π΅ΡΡΠΈΡ ΠΈΠ½ΡΠ°ΡΠΊΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π°, Π² Π°ΠΌΠ±ΡΠ»Π°ΡΠΎΡΠ½ΡΡ ΡΡΠ»ΠΎΠ²ΠΈΡΡ Π·Π° 2001-2006 Π³Π³. (ΡΠ°ΡΠΌΠ°ΠΊΠΎΡΠΏΠΈΠ΄Π΅ΠΌΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅)
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.ΠΡΠΎΠ²Π΅Π΄Π΅Π½ Π΄Π²ΡΡ
ΡΡΠ°ΠΏΠ½ΡΠΉ ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· Π°ΠΌΠ±ΡΠ»Π°ΡΠΎΡΠ½ΡΡ
ΠΊΠ°ΡΡ 1375 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΊΠ°ΡΠ΄ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π΄ΠΈΡΠΏΠ°Π½ΡΠ΅ΡΠ°, ΠΏΠ΅ΡΠ΅Π½Π΅ΡΡΠΈΡ
ΠΈΠ½ΡΠ°ΡΠΊΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π°, Π½Π° ΠΏΡΠ΅Π΄ΠΌΠ΅Ρ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ ΠΌΠ΅ΠΆΠ΄ΡΠ½Π°ΡΠΎΠ΄Π½ΡΡ
ΠΈ ΠΎΡΠ΅ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ
ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΉ ΠΏΠΎ ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½ΡΠΎΠ·Π½ΠΎΠΉ Π²ΡΠΎΡΠΈΡΠ½ΠΎΠΉ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ΅ Π‘Π‘Π Π·Π° ΠΏΠ΅ΡΠΈΠΎΠ΄ 2001-2006 Π³Π³. ΠΠ° ΡΡΠ°ΠΏΠ΅ Π°ΠΌΠ±ΡΠ»Π°ΡΠΎΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Π²ΡΡΠ²Π»Π΅Π½ΠΎ Π½Π΅ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΈΠ΅ ΠΌΠ΅ΠΆΠ΄Ρ ΡΡΡΠ΅ΡΡΠ²ΡΡΡΠΈΠΌΠΈ ΡΡΠ°Π½Π΄Π°ΡΡΠ°ΠΌΠΈ ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½ΡΠΎΠ·Π½ΠΎΠΉ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ ΠΈ ΠΈΡ
ΡΠ΅Π°Π»ΠΈΠ·Π°ΡΠΈΠ΅ΠΉ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° ΡΠΎ, ΡΡΠΎ ΠΎΡΠ½ΠΎΠ²Π½ΡΠ΅ Π³ΡΡΠΏΠΏΡ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² ΡΡΠ°Π»ΠΈ Π½Π°Π·Π½Π°ΡΠ°ΡΡΡΡ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ ΡΠ°ΡΠ΅, Π±ΠΎΠ»ΡΡΠ΅ ΡΠ΅ΠΌ Ρ ΠΏΠΎΠ»ΠΎΠ²ΠΈΠ½Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Π½Π΅ Π±ΡΠ»ΠΈ Π΄ΠΎΡΡΠΈΠ³Π½ΡΡΡ ΡΠ΅Π»Π΅Π²ΡΠ΅ ΡΡΠΎΠ²Π½ΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ Π»ΠΈΠΏΠΈΠ΄Π½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΠΈΠ»Ρ ΠΈ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ. Π Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΠΉ ΠΌΠ΅ΡΠ΅ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠ°ΡΡ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡΡΡ Π² Π°ΠΌΠ±ΡΠ»Π°ΡΠΎΡΠ½ΡΡ
ΡΡΠ»ΠΎΠ²ΠΈΡΡ
Π°Π½ΡΠΈΠ°Π³ΡΠ΅Π³Π°Π½ΡΡ, Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΡ ΠΈ ΡΡΠ°ΡΠΈΠ½Ρ
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. Β© 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
ΠΡΠΎΠ±Π»Π΅ΠΌΠ° Π·Π»ΠΎΡΠΏΠΎΡΡΠ΅Π±Π»Π΅Π½ΠΈΡ ΡΡΠ°ΡΡΠΈΠ΅ΠΌ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡΡ ΡΠ°Π½Π½ΠΈΡ ΡΠ°Π· ΡΠΎ ΡΡΠΎΡΠΎΠ½Ρ Π·Π΄ΠΎΡΠΎΠ²ΡΡ Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΡΠ΅Π²
This article discusses important problem of early phase clinical trials - over-volunteering. The overlapping or dual enrollment of healthy volunteers is a potential high risk not only to study subjects, but also to commercial sponsors because it could cause the delay in advancement of promising drug candidates. The problem of over-volunteering is payed special attention by clinical research professionals in foreign countries. Guidelines for early phase clinical trials recommend implementation of different control and prevention measures of multiple enrollment. The most effective instrument to prevent over-volunteering is considered to be a central internet-based registry of healthy volunteers. Such registries operate in various countries and differ in structure, scope of information collected, types of funding and management. The general operating principles of such registries are described on the example of TOPS data base. TOPS is Π° special system to prevent over-volunteering that is used by UK phase 1 units. In conclusion, authors urge regulatory authorities and pharmaceutical companies to approach this problem closely because over-volunteering is already a burning issue in our country. It is essential to improve relevant regulatory framework and launch central registries of healthy subjects with regard to international experience.Π Π½Π°ΡΡΠΎΡΡΠ΅ΠΉ ΡΡΠ°ΡΡΠ΅ Π°Π²ΡΠΎΡΡ Π·Π°ΡΡΠ°Π³ΠΈΠ²Π°ΡΡ Π²Π°ΠΆΠ½ΡΡ ΠΏΡΠΎΠ±Π»Π΅ΠΌΡ ΠΏΡΠ°ΠΊΡΠΈΠΊΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΡΠ°Π½Π½ΠΈΡ
ΡΠ°Π· - ΠΏΡΠΎΠ±Π»Π΅ΠΌΡ Π·Π»ΠΎΡΠΏΠΎΡΡΠ΅Π±Π»Π΅Π½ΠΈΡ ΡΡΠ°ΡΡΠΈΠ΅ΠΌ Π² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡΡ
ΡΠΎ ΡΡΠΎΡΠΎΠ½Ρ Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΡΠ΅Π² (Β«ΠΏΡΠΎΡΠ΅ΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ΅Β» Π²ΠΎΠ»ΠΎΠ½ΡΡΡΡΡΠ²ΠΎ). ΠΠ»ΠΎΡΠΏΠΎΡΡΠ΅Π±Π»Π΅Π½ΠΈΠ΅ ΡΡΠ°ΡΡΠΈΠ΅ΠΌ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡΡ
Π½Π΅ΡΡΡ Π² ΡΠ΅Π±Π΅ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΠΈΡΠΊΠΈ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ Π΄Π»Ρ ΡΠ°ΠΌΠΈΡ
Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΡΠ΅Π², Π½ΠΎ ΠΈ Π΄Π»Ρ ΡΠ°Π·ΡΠ°Π±ΠΎΡΡΠΈΠΊΠΎΠ² Π½ΠΎΠ²ΡΡ
Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ², Π½Π°Π½ΠΎΡΡ ΠΏΠΎΡΠ»Π΅Π΄Π½ΠΈΠΌ ΠΎΡΡΡΠΈΠΌΡΠΉ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΡΠ΅ΡΠ±. ΠΠ°Π½Π½ΠΎΠΉ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠ΅ ΡΠ΄Π΅Π»ΡΠ΅ΡΡΡ ΠΎΡΠΎΠ±ΠΎΠ΅ Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅ ΡΠΎ ΡΡΠΎΡΠΎΠ½Ρ ΠΏΡΠΎΡΠ΅ΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΎΠΎΠ±ΡΠ΅ΡΡΠ²Π° Π·Π°ΠΏΠ°Π΄Π½ΡΡ
ΡΡΡΠ°Π½. Π Π·Π°ΡΡΠ±Π΅ΠΆΠ½ΡΡ
Π½ΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΡΡ
Π΄ΠΎΠΊΡΠΌΠ΅Π½ΡΠ°Ρ
, ΡΠ΅Π³ΡΠ»ΠΈΡΡΡΡΠΈΡ
ΡΠ°Π½Π½ΠΈΠ΅ ΡΠ°Π·Ρ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Ρ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΈ ΠΏΠΎ Π²Π½Π΅Π΄ΡΠ΅Π½ΠΈΡ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
ΠΌΠ΅Ρ ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ ΠΈ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ Β«ΠΏΡΠΎΡΠ΅ΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎΒ» Π²ΠΎΠ»ΠΎΠ½ΡΡΡΡΡΠ²Π°. ΠΠ°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠΎΠΌ ΠΏΡΠΈΠ·Π½Π°Π½Ρ ΡΠ΅Π½ΡΡΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΡΠ΅ ΡΠ»Π΅ΠΊΡΡΠΎΠ½Π½ΡΠ΅ ΡΠ΅Π³ΠΈΡΡΡΡ (Π±Π°Π·Ρ Π΄Π°Π½Π½ΡΡ
) Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΡΠ΅Π², ΠΊΠΎΡΠΎΡΡΠ΅ ΡΠΎΠ·Π΄Π°Π½Ρ Π½Π° ΡΠ΅ΡΡΠΈΡΠΎΡΠΈΠΈ ΡΡΠ΄Π° ΡΡΡΠ°Π½ ΠΠ²ΡΠΎΠΏΡ ΠΈ Π‘Π΅Π²Π΅ΡΠ½ΠΎΠΉ ΠΠΌΠ΅ΡΠΈΠΊΠΈ. ΠΡΠΈ ΡΡΠΎΠΌ ΡΠ΅Π³ΠΈΡΡΡΡ Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΡΠ΅Π² ΡΠ°Π·Π»ΠΈΡΠ°ΡΡΡΡ ΠΏΠΎ ΡΡΡΡΠΊΡΡΡΠ΅, ΠΎΠ±ΡΡΠΌΡ ΡΠΎΠ±ΠΈΡΠ°Π΅ΠΌΠΎΠΉ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠΈ, ΡΠΈΠΏΠ°ΠΌ ΡΠΈΠ½Π°Π½ΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΈ ΡΠΏΡΠ°Π²Π»Π΅Π½ΠΈΡ. ΠΠ° ΠΏΡΠΈΠΌΠ΅ΡΠ΅ ΡΠΈΡΡΠ΅ΠΌΡ TOPS, ΠΊΠΎΡΠΎΡΠ°Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΡΠ΅ΡΡΡ ΡΠ΅Π½ΡΡΠ°ΠΌΠΈ 1-ΠΉ ΡΠ°Π·Ρ ΠΠ΅Π»ΠΈΠΊΠΎΠ±ΡΠΈΡΠ°Π½ΠΈΠΈ, ΠΎΠΏΠΈΡΠ°Π½ Π°Π»Π³ΠΎΡΠΈΡΠΌ ΡΠ°Π±ΠΎΡΡ ΡΠ°ΠΊΠΈΡ
ΡΠ΅Π³ΠΈΡΡΡΠΎΠ². Π Π·Π°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠΈ Π°Π²ΡΠΎΡΡ ΠΏΡΠΈΠ·ΡΠ²Π°ΡΡ ΡΠ΅Π³ΡΠ»ΡΡΠΎΡΠ° ΠΈ ΡΠ°ΡΠΌΠ°ΡΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΊΠΎΠΌΠΏΠ°Π½ΠΈΠΈ ΠΎΠ±ΡΠ°ΡΠΈΡΡ ΠΎΡΠΎΠ±ΠΎΠ΅ Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅ Π½Π° Π΄Π°Π½Π½ΡΡ ΠΏΡΠΎΠ±Π»Π΅ΠΌΡ, ΡΡΠ°Π²ΡΡΡ Π°ΠΊΡΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΈ Π΄Π»Ρ ΠΎΡΠ΅ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΡΠ°Π½Π½ΠΈΡ
ΡΠ°Π·. ΠΠ΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎ ΡΠΎΠ²Π΅ΡΡΠ΅Π½ΡΡΠ²ΠΎΠ²Π°ΡΡ Π½ΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΡΡ Π±Π°Π·Ρ, ΡΠ΅Π³ΡΠ»ΠΈΡΡΡΡΡΡ Π΄Π°Π½Π½ΡΠΉ Π°ΡΠΏΠ΅ΠΊΡ, Π° ΡΠ°ΠΊΠΆΠ΅ ΡΠΎΠ·Π΄Π°Π²Π°ΡΡ ΡΠ΅Π½ΡΡΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΡΠ΅ ΡΠ΅Π³ΠΈΡΡΡΡ Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΡΠ΅Π² Ρ ΡΡΡΡΠΎΠΌ ΠΌΠ΅ΠΆΠ΄ΡΠ½Π°ΡΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΎΠΏΡΡΠ°
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 Ξ²-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 Ξ²-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
ΠΠ½ΠΎΠ³ΠΎΡΠ°ΠΊΡΠΎΡΠ½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΏΡΠΈΠ²Π΅ΡΠΆΠ΅Π½Π½ΠΎΡΡΠΈ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΡΡΠΎΠ² ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ³ΠΎ Π·Π²Π΅Π½Π° ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠΌ ΠΏΠΎΠ΄Ρ ΠΎΠ΄Π°ΠΌ ΠΊ ΡΠ°ΡΠΌΠ°ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌΡ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΠΉ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΡΠ΅ΡΠ΄ΡΠ°
Aim. To study predictors of primary care physician adherence to guideline-recommended pharmacotherapy of stable coronary artery disease. Material and methods. This pharmacoepidemiologic cross-sectional study was conducted in primary care setting of Moscow. 805 patients (mean age 68.9Β±9.9 years, males 51.4%) with established stable coronary artery disease (SCAD) were included. Demography, medical history, prescribed pharmacological treatment data were obtained. Physician adherence to guideline-recommended pharmacotherapy (GRP) of SCAD was evaluated based on the Class I guideline recommendations. Pharmacotherapeutic guideline adherence index (PGAI) was introduced as composite quality indicator, calculated in line with "all-or-none" rule and in regard with documented contraindications. To search for predictors of adherence the patient population was divided in two groups by level of physician adherence measured by PGAI. Statistical analysis was performed by IBM SPSS Statistics 16.0, the level of statistical significance was set at p<0.05. Results. The prescription rates of essential drug therapies of SCAD (regarding contraindications) were quite adequate: Beta-blockers/calcium channel blockers - 90,1%, acetylsalicylic acid/clopidogrel/oral anticoagulants - 95,7%, statins/ezetimibe - 86,3%, angiotensin-converting enzyme inhibitors/ angiotensin II receptor blockers - 87,6%. 82,9% (n=667) of patients were prescribed treatment for SCAD in compliance with the guidelines. Suboptimal pharmacotherapy was identified in 17,1% (n=138) of patients. These groups were similar in sex distribution (males 50,4 vs. 56,5%; p=0,188). Mean age tended to be lower in GRP adherent group (68,5Β±9,9 vs. 70,6Β±10,0 years; p=0,052). Bivariable analysis showed that good adherence to guideline-recommended pharmacotherapy was associated with higher prevalence of stable angina (66,4 vs. 53,6%; p=0,004), arterial hypertension (93,3 vs. 79,7%; p<0,001) and dyslipidemia (21,4 vs. 9,4%; p<0,001) and with lower prevalence of myocardial infarction (48,1 vs. 67,4%; p<0,001). Logistic multivariable regression model (gender, age, 6 medical history variables) identified 6 patient-related factors that were significantly associated with physician adherence to guideline-recommended pharmacotherapy: Age (odds ratio [OR] 0,97; 95% confidence interval [CI] 0,95-0,99; p=0,009), arterial hypertension (OR 3,89; 95%CI 2,19-6,90; p<0,001), dyslipidemia (OR 2,31; 95%CI 1,23-4,34; p=0,009), chronic heart failure (OR 1,95; 95%CI 1,06-3,61; p=0,032), revascularization (OR 2,14; 95%CI 1,33-3,45; p=0,002), myocardial infarction (OR 0,28; 95%CI 0,16-0,48; p<0,001). Conclusion. Primary care cardiologist adherence to guideline-recommended pharmacotherapy of SCAD was satisfactory evaluated as 82,9% by composite indicator PGAI. Arterial hypertension, heart failure, dyslipidemia revascularization were predictors of better physician adherence. History of myocardial infarction and older age were risk factors of non-adherence. Identification of patient-related factors associated with underperformance may facilitate tailoring quality improvement interventions in primary care of coronary patients. Β© 2021 Stolichnaya Izdatelskaya Kompaniya. All rights reserved.Π¦Π΅Π»Ρ. ΠΠ·ΡΡΠΈΡΡ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΡ ΠΏΡΠΈΠ²Π΅ΡΠΆΠ΅Π½Π½ΠΎΡΡΠΈ Π²ΡΠ°ΡΠ΅ΠΉ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ³ΠΎ Π·Π²Π΅Π½Π° ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΡΠΌ Π² ΠΎΠ±Π»Π°ΡΡΠΈ ΡΠ°ΡΠΌΠ°ΠΊΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΠΉ
ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΡΠ΅ΡΠ΄ΡΠ° (ΠΠΠ‘).
ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π Π°ΠΌΠ±ΡΠ»Π°ΡΠΎΡΠ½ΠΎ-ΠΏΠΎΠ»ΠΈΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΌ ΡΡΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠΈ Π³. ΠΠΎΡΠΊΠ²Ρ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΎ ΡΠ°ΡΠΌΠ°ΠΊΠΎΡΠΏΠΈΠ΄Π΅ΠΌΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΠΏΠΎΠΏΠ΅ΡΠ΅ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ΅Π·Π°. ΠΠΊΠ»ΡΡΠ΅Π½ΠΎ 805 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (ΡΡΠ΅Π΄Π½ΠΈΠΉ Π²ΠΎΠ·ΡΠ°ΡΡ 68,9Β±9,9 Π»Π΅Ρ; 51,4% ΠΌΡΠΆΡΠΈΠ½) Ρ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π½ΡΠΌ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΠΉ
ΠΠΠ‘. Π Π΅Π³ΠΈΡΡΡΠ°ΡΠΈΠΈ ΠΏΠΎΠ΄Π»Π΅ΠΆΠ°Π»ΠΈ Π΄Π°Π½Π½ΡΠ΅ Π΄Π΅ΠΌΠΎΠ³ΡΠ°ΡΠΈΠΈ, ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠ³ΠΎ Π°Π½Π°ΠΌΠ½Π΅Π·Π° ΠΈ ΡΠ°ΡΠΌΠ°ΠΊΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ. ΠΡΠΈΠ²Π΅ΡΠΆΠ΅Π½Π½ΠΎΡΡΡ Π²ΡΠ°ΡΠ΅ΠΉ ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΈΡ ΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈ Π½Π°Π·Π½Π°ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½ΡΠΎΠ·Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΎΡΠ½ΠΎΠ²Π½ΡΠΌ ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΡΠΌ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΉ
(ΠΊΠ»Π°ΡΡ I). ΠΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½ ΡΠ°ΡΠΌΠ°ΠΊΠΎΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΈΠ½Π΄Π΅ΠΊΡ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΈΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΡΠΌ (Π€ΠΠ‘ΠΠ ), ΡΠ°ΡΡΡΠΈΡΡΠ²Π°Π΅ΠΌΡΠΉ ΡΠΎΠ³Π»Π°ΡΠ½ΠΎ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Ρ Β«Π²ΡΠ΅ ΠΈΠ»ΠΈ Π½ΠΈΡΠ΅Π³ΠΎΒ» ΠΈ Ρ ΡΡΠ΅ΡΠΎΠΌ ΠΏΡΠΎΡΠΈΠ²ΠΎΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΠΉ. ΠΠ»Ρ Π°Π½Π°Π»ΠΈΠ·Π° ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠΎΠ² ΠΏΡΠΈΠ²Π΅ΡΠΆΠ΅Π½Π½ΠΎΡΡΠΈ ΠΏΠΎΠΏΡΠ»ΡΡΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π±ΡΠ»Π° ΡΠ°Π·Π΄Π΅Π»Π΅Π½Π° Π½Π°
Π΄Π²Π΅ Π³ΡΡΠΏΠΏΡ Π² ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΈΠΈ Ρ ΠΎΡΠ΅Π½ΠΊΠΎΠΉ ΠΏΠΎ Π€ΠΠ‘ΠΠ .
Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π‘ΡΡΡΠΊΡΡΡΠ° Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠΉ, ΠΎΠ±ΡΠ·Π°ΡΠ΅Π»ΡΠ½ΡΡ
Π΄Π»Ρ ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½ΡΠΎΠ·Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΠΉ ΠΠΠ‘ ΡΠ°ΡΠΌΠ°ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Π³ΡΡΠΏΠΏ (Ρ ΡΡΠ΅ΡΠΎΠΌ ΠΏΡΠΎΡΠΈΠ²ΠΎΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΠΉ), Π½Π°Ρ
ΠΎΠ΄ΠΈΠ»Π°ΡΡ Π½Π° Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎ ΠΏΡΠΈΠ΅ΠΌΠ»Π΅ΠΌΠΎΠΌ ΡΡΠΎΠ²Π½Π΅: Π±Π΅ΡΠ°-Π°Π΄ΡΠ΅Π½ΠΎΠ±Π»ΠΎΠΊΠ°ΡΠΎΡΡ/Π±Π»ΠΎΠΊΠ°ΡΠΎΡΡ ΠΊΠ°Π»ΡΡΠΈΠ΅Π²ΡΡ
ΠΊΠ°Π½Π°Π»ΠΎΠ² β 90,1%, Π°ΡΠ΅ΡΠΈΠ»ΡΠ°Π»ΠΈΡΠΈΠ»ΠΎΠ²Π°Ρ ΠΊΠΈΡΠ»ΠΎΡΠ°/ΠΊΠ»ΠΎΠΏΠΈΠ΄ΠΎΠ³ΡΠ΅Π»/ΠΎΡΠ°Π»ΡΠ½ΡΠ΅ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΡ β 95,7%, ΡΡΠ°ΡΠΈΠ½Ρ/ΡΠ·Π΅ΡΠΈΠΌΠΈΠ± β 86,3%, ΠΈΠ½Π³ΠΈΠ±ΠΈΡΠΎΡΡ Π°Π½Π³ΠΈΠΎΡΠ΅Π½Π·ΠΈΠ½-ΠΏΡΠ΅Π²ΡΠ°ΡΠ°ΡΡΠ΅Π³ΠΎ ΡΠ΅ΡΠΌΠ΅Π½ΡΠ°/Π°Π½ΡΠ°Π³ΠΎΠ½ΠΈΡΡΡ ΡΠ΅ΡΠ΅ΠΏΡΠΎΡΠΎΠ² Π°Π½Π³ΠΈΠΎΡΠ΅Π½Π·ΠΈΠ½Π° II β 87,6%. Π‘ΠΎΠ³Π»Π°ΡΠ½ΠΎ ΠΎΡΠ΅Π½ΠΊΠ΅ ΠΏΠΎ Π€ΠΠ‘ΠΠ 82,9% (n=667) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΠΎΠ»ΡΡΠ°Π»ΠΈ
ΡΠ°ΡΠΌΠ°ΠΊΠΎΡΠ΅ΡΠ°ΠΏΠΈΡ Π² ΠΏΠΎΠ»Π½ΠΎΠΌ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΈΠΈ Ρ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΡΠΌΠΈ, 17,1% (n=138) Π±ΠΎΠ»ΡΠ½ΡΠΌ ΡΠ°ΡΠΌΠ°ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π±ΡΠ»ΠΎ
Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΎ Ρ ΠΎΡΠΊΠ»ΠΎΠ½Π΅Π½ΠΈΠ΅ΠΌ ΠΎΡ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΉ. ΠΠ°Π½Π½ΡΠ΅ Π³ΡΡΠΏΠΏΡ Π½Π΅ ΠΎΡΠ»ΠΈΡΠ°Π»ΠΈΡΡ ΠΏΠΎ Π³Π΅Π½Π΄Π΅ΡΠ½ΠΎΠΌΡ ΡΠ°ΡΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ (ΠΌΡΠΆΡΠΈΠ½ 50,4 ΠΏΡΠΎΡΠΈΠ² 56,5%;
p=0,188), ΡΡΠ΅Π΄Π½ΠΈΠΉ Π²ΠΎΠ·ΡΠ°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΈΠΌΠ΅Π» ΡΠ΅Π½Π΄Π΅Π½ΡΠΈΡ ΠΊ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ Π² Π³ΡΡΠΏΠΏΠ΅ Ρ Π²ΡΡΠΎΠΊΠΎΠΉ ΡΠ°ΡΠΌΠ°ΠΊΠΎΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠΈΠ²Π΅ΡΠΆΠ΅Π½Π½ΠΎΡΡΡΡ Π²ΡΠ°ΡΠ΅ΠΉ
(68,5Β±9,9 ΠΏΡΠΎΡΠΈΠ² 70,6Β±10,0 Π»Π΅Ρ; p=0,052). Π Π°Π½Π°ΠΌΠ½Π΅Π·Π΅ Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΡΠΎΠΉ ΠΆΠ΅ Π³ΡΡΠΏΠΏΡ ΡΠ°ΡΠ΅ Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈΡΡ ΡΡΠ°Π±ΠΈΠ»ΡΠ½Π°Ρ ΡΡΠ΅Π½ΠΎΠΊΠ°ΡΠ΄ΠΈΡ (66,4 ΠΏΡΠΎΡΠΈΠ²
53,6%; p=0,004), Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½Π°Ρ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΡ (93,3 ΠΏΡΠΎΡΠΈΠ² 79,7%; p<0,001) ΠΈ Π΄ΠΈΡΠ»ΠΈΠΏΠΈΠ΄Π΅ΠΌΠΈΡ (21,4 ΠΏΡΠΎΡΠΈΠ² 9,4%; p<0,001), ΡΠ΅ΠΆΠ΅ β
ΠΈΠ½ΡΠ°ΡΠΊΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° (48,1 ΠΏΡΠΎΡΠΈΠ² 67,4%; p<0,001). ΠΠΎ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°ΠΌ ΠΌΠ½ΠΎΠ³ΠΎΡΠ°ΠΊΡΠΎΡΠ½ΠΎΠ³ΠΎ ΡΠ΅Π³ΡΠ΅ΡΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ Π°Π½Π°Π»ΠΈΠ·Π° (ΠΏΠΎΠ», Π²ΠΎΠ·ΡΠ°ΡΡ, 6 Π°Π½Π°ΠΌΠ½Π΅ΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊ) ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΎ, ΡΡΠΎ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ Π²ΠΎΠ·ΡΠ°ΡΡΠ° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π½Π° 1 Π³ΠΎΠ΄ ΡΠ½ΠΈΠΆΠ°Π»ΠΎ ΡΠ°Π½ΡΡ Π½Π° Π²ΡΡΠΎΠΊΡΡ ΡΠ°ΡΠΌΠ°ΠΊΠΎΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΡΡ ΠΏΡΠΈΠ²Π΅ΡΠΆΠ΅Π½Π½ΠΎΡΡΡ Π²ΡΠ°ΡΠ° Π½Π° 3% (p=0,009). ΠΠ½Π°ΡΠΈΠΌΠΎΠ΅ Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠΎΠ² Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΉ ΠΏΠΎΠΊΠ°Π·Π°Π»ΠΈ: Π½Π°Π»ΠΈΡΠΈΠ΅ Ρ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΠΈ (ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΡΠ°Π½ΡΠΎΠ² [ΠΠ¨] 3,89; 95% Π΄ΠΎΠ²Π΅ΡΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΠΈΠ½ΡΠ΅ΡΠ²Π°Π» [ΠΠ] 2,19-6,90; p<0,001), Π΄ΠΈΡΠ»ΠΈΠΏΠΈΠ΄Π΅ΠΌΠΈΠΈ
(ΠΠ¨ 2,31; 95%ΠΠ 1,23-4,34; p=0,009), Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ (ΠΠ¨ 1,95; 95%ΠΠ 1,06-3,61; p=0,032), ΡΠ΅Π²Π°ΡΠΊΡΠ»ΡΡΠΈΠ·Π°ΡΠΈΠΈ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° Π² Π°Π½Π°ΠΌΠ½Π΅Π·Π΅ (ΠΠ¨ 2,14; 95%ΠΠ 1,33-3,45; p=0,002), Π° Π½Π°Π»ΠΈΡΠΈΠ΅ Π² Π°Π½Π°ΠΌΠ½Π΅Π·Π΅ ΠΈΠ½ΡΠ°ΡΠΊΡΠ° ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° ΡΠ½ΠΈΠΆΠ°Π»ΠΎ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΡ
Π²ΡΡΠΎΠΊΠΎΠΉ ΠΏΡΠΈΠ²Π΅ΡΠΆΠ΅Π½Π½ΠΎΡΡΠΈ (ΠΠ¨ 0,28; 95%ΠΠ 0,16-0,48; p<0,001).
ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π ΡΡΠ»ΠΎΠ²ΠΈΡΡ
Π°ΠΌΠ±ΡΠ»Π°ΡΠΎΡΠ½ΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠΈ ΡΡΠΎΠ²Π΅Π½Ρ ΠΏΡΠΈΠ²Π΅ΡΠΆΠ΅Π½Π½ΠΎΡΡΠΈ Π²ΡΠ°ΡΠ΅ΠΉ-ΠΊΠ°ΡΠ΄ΠΈΠΎΠ»ΠΎΠ³ΠΎΠ² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΡΠΌ ΠΎΠΊΠ°Π·Π°Π»ΡΡ
ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΡΠΌ, ΡΠΎΡΡΠ°Π²ΠΈΠ² 82,9% ΠΏΠΎ ΠΎΡΠ΅Π½ΠΊΠ΅ Ρ ΠΏΠΎΠΌΠΎΡΡΡ Π€ΠΠ‘ΠΠ . ΠΠ°Π»ΠΈΡΠΈΠ΅ Π² Π°Π½Π°ΠΌΠ½Π΅Π·Π΅ Π±ΠΎΠ»ΡΠ½ΡΡ
Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΠΈ, ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ
Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ, Π΄ΠΈΡΠ»ΠΈΠΏΠΈΠ΄Π΅ΠΌΠΈΠΈ ΠΈ ΡΠ΅Π²Π°ΡΠΊΡΠ»ΡΡΠΈΠ·Π°ΡΠΈΠΈ ΠΏΠΎΠ²ΡΡΠ°Π»ΠΎ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΡ Π²ΡΡΠΎΠΊΠΎΠΉ ΡΠ°ΡΠΌΠ°ΠΊΠΎΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠΈΠ²Π΅ΡΠΆΠ΅Π½Π½ΠΎΡΡΠΈ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΡΡΠΎΠ², Π° ΠΏΠ΅ΡΠ΅Π½Π΅ΡΠ΅Π½Π½ΡΠΉ ΠΈΠ½ΡΠ°ΡΠΊΡ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° ΠΈ Π±ΠΎΠ»Π΅Π΅ ΠΏΠΎΠΆΠΈΠ»ΠΎΠΉ Π²ΠΎΠ·ΡΠ°ΡΡ ΡΠ½ΠΈΠΆΠ°Π»ΠΎ. ΠΡΡΠ²Π»Π΅Π½ΠΈΠ΅ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠΎΠ² Π½Π΅ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΡΠΈΠ²Π΅ΡΠΆΠ΅Π½Π½ΠΎΡΡΠΈ
Π΄ΠΎΠ»ΠΆΠ½ΠΎ ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΠΎΠ²Π°ΡΡ Π±ΠΎΠ»Π΅Π΅ ΡΠ΅Π»Π΅Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½Π½ΠΎΠΉ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠ΅ ΠΌΠ΅Ρ ΠΏΠΎ Π΄Π°Π»ΡΠ½Π΅ΠΉΡΠ΅ΠΌΡ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΡ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΡΠ°ΡΠΌΠ°ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΠΉ ΠΠΠ‘ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ³ΠΎ Π·Π²Π΅Π½Π°
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
ΠΡΠΎΠ±Π»Π΅ΠΌΠ° Π·Π»ΠΎΡΠΏΠΎΡΡΠ΅Π±Π»Π΅Π½ΠΈΡ ΡΡΠ°ΡΡΠΈΠ΅ΠΌ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡΡ ΡΠ°Π½Π½ΠΈΡ ΡΠ°Π· ΡΠΎ ΡΡΠΎΡΠΎΠ½Ρ Π·Π΄ΠΎΡΠΎΠ²ΡΡ Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΡΠ΅Π²
This article discusses important problem of early phase clinical trials - over-volunteering. The overlapping or dual enrollment of healthy volunteers is a potential high risk not only to study subjects, but also to commercial sponsors because it could cause the delay in advancement of promising drug candidates. The problem of over-volunteering is payed special attention by clinical research professionals in foreign countries. Guidelines for early phase clinical trials recommend implementation of different control and prevention measures of multiple enrollment. The most effective instrument to prevent over-volunteering is considered to be a central internet-based registry of healthy volunteers. Such registries operate in various countries and differ in structure, scope of information collected, types of funding and management. The general operating principles of such registries are described on the example of TOPS data base. TOPS is Π° special system to prevent over-volunteering that is used by UK phase 1 units. In conclusion, authors urge regulatory authorities and pharmaceutical companies to approach this problem closely because over-volunteering is already a burning issue in our country. It is essential to improve relevant regulatory framework and launch central registries of healthy subjects with regard to international experience.Π Π½Π°ΡΡΠΎΡΡΠ΅ΠΉ ΡΡΠ°ΡΡΠ΅ Π°Π²ΡΠΎΡΡ Π·Π°ΡΡΠ°Π³ΠΈΠ²Π°ΡΡ Π²Π°ΠΆΠ½ΡΡ ΠΏΡΠΎΠ±Π»Π΅ΠΌΡ ΠΏΡΠ°ΠΊΡΠΈΠΊΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΡΠ°Π½Π½ΠΈΡ
ΡΠ°Π· - ΠΏΡΠΎΠ±Π»Π΅ΠΌΡ Π·Π»ΠΎΡΠΏΠΎΡΡΠ΅Π±Π»Π΅Π½ΠΈΡ ΡΡΠ°ΡΡΠΈΠ΅ΠΌ Π² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡΡ
ΡΠΎ ΡΡΠΎΡΠΎΠ½Ρ Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΡΠ΅Π² (Β«ΠΏΡΠΎΡΠ΅ΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ΅Β» Π²ΠΎΠ»ΠΎΠ½ΡΡΡΡΡΠ²ΠΎ). ΠΠ»ΠΎΡΠΏΠΎΡΡΠ΅Π±Π»Π΅Π½ΠΈΠ΅ ΡΡΠ°ΡΡΠΈΠ΅ΠΌ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡΡ
Π½Π΅ΡΡΡ Π² ΡΠ΅Π±Π΅ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΠΈΡΠΊΠΈ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ Π΄Π»Ρ ΡΠ°ΠΌΠΈΡ
Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΡΠ΅Π², Π½ΠΎ ΠΈ Π΄Π»Ρ ΡΠ°Π·ΡΠ°Π±ΠΎΡΡΠΈΠΊΠΎΠ² Π½ΠΎΠ²ΡΡ
Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ², Π½Π°Π½ΠΎΡΡ ΠΏΠΎΡΠ»Π΅Π΄Π½ΠΈΠΌ ΠΎΡΡΡΠΈΠΌΡΠΉ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΡΠ΅ΡΠ±. ΠΠ°Π½Π½ΠΎΠΉ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠ΅ ΡΠ΄Π΅Π»ΡΠ΅ΡΡΡ ΠΎΡΠΎΠ±ΠΎΠ΅ Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅ ΡΠΎ ΡΡΠΎΡΠΎΠ½Ρ ΠΏΡΠΎΡΠ΅ΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΎΠΎΠ±ΡΠ΅ΡΡΠ²Π° Π·Π°ΠΏΠ°Π΄Π½ΡΡ
ΡΡΡΠ°Π½. Π Π·Π°ΡΡΠ±Π΅ΠΆΠ½ΡΡ
Π½ΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΡΡ
Π΄ΠΎΠΊΡΠΌΠ΅Π½ΡΠ°Ρ
, ΡΠ΅Π³ΡΠ»ΠΈΡΡΡΡΠΈΡ
ΡΠ°Π½Π½ΠΈΠ΅ ΡΠ°Π·Ρ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Ρ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΈ ΠΏΠΎ Π²Π½Π΅Π΄ΡΠ΅Π½ΠΈΡ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
ΠΌΠ΅Ρ ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ ΠΈ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ Β«ΠΏΡΠΎΡΠ΅ΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎΒ» Π²ΠΎΠ»ΠΎΠ½ΡΡΡΡΡΠ²Π°. ΠΠ°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠΎΠΌ ΠΏΡΠΈΠ·Π½Π°Π½Ρ ΡΠ΅Π½ΡΡΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΡΠ΅ ΡΠ»Π΅ΠΊΡΡΠΎΠ½Π½ΡΠ΅ ΡΠ΅Π³ΠΈΡΡΡΡ (Π±Π°Π·Ρ Π΄Π°Π½Π½ΡΡ
) Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΡΠ΅Π², ΠΊΠΎΡΠΎΡΡΠ΅ ΡΠΎΠ·Π΄Π°Π½Ρ Π½Π° ΡΠ΅ΡΡΠΈΡΠΎΡΠΈΠΈ ΡΡΠ΄Π° ΡΡΡΠ°Π½ ΠΠ²ΡΠΎΠΏΡ ΠΈ Π‘Π΅Π²Π΅ΡΠ½ΠΎΠΉ ΠΠΌΠ΅ΡΠΈΠΊΠΈ. ΠΡΠΈ ΡΡΠΎΠΌ ΡΠ΅Π³ΠΈΡΡΡΡ Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΡΠ΅Π² ΡΠ°Π·Π»ΠΈΡΠ°ΡΡΡΡ ΠΏΠΎ ΡΡΡΡΠΊΡΡΡΠ΅, ΠΎΠ±ΡΡΠΌΡ ΡΠΎΠ±ΠΈΡΠ°Π΅ΠΌΠΎΠΉ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠΈ, ΡΠΈΠΏΠ°ΠΌ ΡΠΈΠ½Π°Π½ΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΈ ΡΠΏΡΠ°Π²Π»Π΅Π½ΠΈΡ. ΠΠ° ΠΏΡΠΈΠΌΠ΅ΡΠ΅ ΡΠΈΡΡΠ΅ΠΌΡ TOPS, ΠΊΠΎΡΠΎΡΠ°Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΡΠ΅ΡΡΡ ΡΠ΅Π½ΡΡΠ°ΠΌΠΈ 1-ΠΉ ΡΠ°Π·Ρ ΠΠ΅Π»ΠΈΠΊΠΎΠ±ΡΠΈΡΠ°Π½ΠΈΠΈ, ΠΎΠΏΠΈΡΠ°Π½ Π°Π»Π³ΠΎΡΠΈΡΠΌ ΡΠ°Π±ΠΎΡΡ ΡΠ°ΠΊΠΈΡ
ΡΠ΅Π³ΠΈΡΡΡΠΎΠ². Π Π·Π°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠΈ Π°Π²ΡΠΎΡΡ ΠΏΡΠΈΠ·ΡΠ²Π°ΡΡ ΡΠ΅Π³ΡΠ»ΡΡΠΎΡΠ° ΠΈ ΡΠ°ΡΠΌΠ°ΡΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΊΠΎΠΌΠΏΠ°Π½ΠΈΠΈ ΠΎΠ±ΡΠ°ΡΠΈΡΡ ΠΎΡΠΎΠ±ΠΎΠ΅ Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅ Π½Π° Π΄Π°Π½Π½ΡΡ ΠΏΡΠΎΠ±Π»Π΅ΠΌΡ, ΡΡΠ°Π²ΡΡΡ Π°ΠΊΡΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΈ Π΄Π»Ρ ΠΎΡΠ΅ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΡΠ°Π½Π½ΠΈΡ
ΡΠ°Π·. ΠΠ΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎ ΡΠΎΠ²Π΅ΡΡΠ΅Π½ΡΡΠ²ΠΎΠ²Π°ΡΡ Π½ΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΡΡ Π±Π°Π·Ρ, ΡΠ΅Π³ΡΠ»ΠΈΡΡΡΡΡΡ Π΄Π°Π½Π½ΡΠΉ Π°ΡΠΏΠ΅ΠΊΡ, Π° ΡΠ°ΠΊΠΆΠ΅ ΡΠΎΠ·Π΄Π°Π²Π°ΡΡ ΡΠ΅Π½ΡΡΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΡΠ΅ ΡΠ΅Π³ΠΈΡΡΡΡ Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π΄ΠΎΠ±ΡΠΎΠ²ΠΎΠ»ΡΡΠ΅Π² Ρ ΡΡΡΡΠΎΠΌ ΠΌΠ΅ΠΆΠ΄ΡΠ½Π°ΡΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΎΠΏΡΡΠ°
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. Β© 2018, Stolichnaya Izdatelskaya Kompaniya