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THE STUDY "REGISTER OF PATIENTS AFTER ACUTE STROKE (REGION)". PART 2. OUTPATIENT PROSPECTIVE REGISTER OF PATIENTS AFTER ACUTE STROKE (ACCORDING TO THE RESULTS OF THE PILOT PHASE OF THE STUDY)

https://doi.org/10.20996/1819-6446-2017-13-1-4-17

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Abstract

Aim. To study particularities of course and outcomes of acute cerebrovascular accident (ACVA), quality of examination and medical treatment within a framework of an outpatient register.

Material and methods. Two outpatient registries were organized on the base of one of Ryazan outpatient clinics within a framework of the pilot phase of the REGION study: the register of patients who had experienced ACVA of any remoteness (ACVA-AR register, n=200) and the register of patients who had visited the outpatient clinic for the first time after cerebral stroke (ACVA-FV register, n=115). Particularities of ACVA development, concomitant cardiovascular diseases (CVD) and noncardiac diseases were analyzed. We estimated accordance of methods of examination and prescribed medical treatment with clinical guidelines. Long-term outcomes were also evaluated in the course of prospective follow-up.

Results. Patients of both  registers had  concomitant CVD (on an average 3 diagnosis) and  noncardiac comorbidity (on an average 1 diagnosis). Majority of patients at the outpatient phase  received inadequate treatment for cardiovascular risk decrease, especially before  reference ACVA. The ACVA-FV register patients as compared to the ACVA-AR ones (who had experienced ACVA on an average 4.8 years earlier) were more often (p<0.05) examined by instrumental and laboratory methods of diagnostics during the post-stroke follow-up in outpatient settings. ACVA-FV register patients as compared to the ACVA-AR ones were also more often (p˂0.05) prescribed prognosis-modifying therapy (statins – 46.9% vs 11%, acetylsalicylic acid – 54.8% vs 28%, ACE inhibitors – 46.1% vs 29%, and anticoagulants in atrial fibrillation – 17.6% vs 2.3%, respectively). Mortality rates in the ACVA-AR and ACVA-FV registers for 2 years were 15.5% and 32.2%, respectively (p=0.005), incidence rates of myocardial infarction – 2.5% and 0%, respectively (p=0.09), recurrent ACVA – 14.5% and 11.3%, respectively, (p=0.42).

Conclusion. Examination and medical treatment of the patients in the outpatient clinic were suboptimal especially before  ACVA development. However examination and treatment quality had improved significantly (although insufficiently) during 5-year time span between ACVA development in the ACVA-AR and ACVA-FV registers. High mortality rate (22.7%) in the first 3 months of outpatient follow-up after ACVA is an unsolved challenge.

About the Authors

S. А. Boytsov
State Research Centre for Preventive Medicine
Russian Federation

Sergey A. Boytsov – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Head of Department of Clinical Cardiology and Molecular Genetics, Director of SRCPM.

Petroverigsky per. 10, Moscow, 101990



M. M. Loukianov
State Research Centre for Preventive Medicine
Russian Federation

Michail M. Loukianov – MD, PhD, Leading Researcher,  Department of Clinical Cardiology and Molecular Genetics.

Petroverigsky per. 10, Moscow, 101990



S. S. Yakushin
I.P. Pavlov Ryazan State Medical University
Russian Federation

Sergey S. Yakushin – MD, PhD, Professor, Head of Chair of Hospital Therapy.

Vysokovoltnaya ul. 9, Ryazan,  390026



S. Yu. Martsevich
State Research Centre for Preventive Medicine
Russian Federation

Sergey Yu. Martsevich – MD, PhD, Professor, Head of Department of Preventive Pharmacotherapy.

Petroverigsky per. 10, Moscow, 101990



L. V. Stakhovskaya
Pirogov Russian National Research Medical University
Russian Federation

Sergey Yu. Martsevich – MD, PhD, Professor, Head of Department of Preventive Pharmacotherapy.

Petroverigsky per. 10, Moscow, 101990



A. N. Vorobyev
I.P. Pavlov Ryazan State Medical University
Russian Federation

Alexander N. Vorobyev – MD, PhD, Assistant, Chair of Hospital Therapy.

Vysokovoltnaya ul. 9, Ryazan,  390026



A. V. Zagrebelnyy
State Research Centre for Preventive Medicine
Russian Federation

Alexander V. Zagrebelnyy – MD, PhD, Senior Researcher,  Department of Preventive Pharmacotherapy.

Petroverigsky per. 10, Moscow, 101990



N. P. Kutishenko
State Research Centre for Preventive Medicine
Russian Federation

Natalia P. Kutishenko – MD, PhD, Head of Laboratory for Pharmacoepidemiological Researchs,  Department of Preventive Pharmacotherapy.

Petroverigsky per. 10, Moscow, 101990



A. N. Kozminsky
I.P. Pavlov Ryazan State Medical University
Russian Federation

Alexander N. Kozminsky – Assistant, Simulation Training Center.

Vysokovoltnaya ul. 9, Ryazan,  390026



K. A. Moseichuk
I.P. Pavlov Ryazan State Medical University
Russian Federation

Ksenia A. Moseichuk – MD, Fellow, Chair of Hospital Therapy.

Vysokovoltnaya ul. 9, Ryazan,  390026



K. G. Pereverzeva
I.P. Pavlov Ryazan State Medical University
Russian Federation

Kristina G. Pereverzeva – MD, Assistant, Chair of Hospital Therapy.

Vysokovoltnaya ul. 9, Ryazan,  390026



E. A. Pravkina
I.P. Pavlov Ryazan State Medical University
Russian Federation

Ekaterina A. Pravkina – MD, Assistant, Chair of Hospital Therapy.

Vysokovoltnaya ul. 9, Ryazan,  390026



E. N. Belova
State Research Centre for Preventive Medicine
Russian Federation

Ekaterina N. Belova – Programmer, Laboratory of Biostatistics, Department of Epidemiology of Chronic Non-Communicable Diseases.

Petroverigsky per. 10, Moscow, 101990



E. V. Kudryashov
State Research Centre for Preventive Medicine
Russian Federation

Egor V. Kudryashov – Programmer, Laboratory of Biostatistics, Department of Epidemiology of Chronic Non-Communicable Diseases.

Petroverigsky per. 10, Moscow, 101990



A. D. Deev
State Research Centre for Preventive Medicine
Russian Federation

Alexander D. Deev – PhD (in Physics and Mathematics), Head of Laboratory of Biostatistics, Department of Epidemiology of Chronic Non-Communicable Diseases.

Petroverigsky per. 10, Moscow, 101990



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For citation:


Boytsov S.А., Loukianov M.M., Yakushin S.S., Martsevich S.Y., Stakhovskaya L.V., Vorobyev A.N., Zagrebelnyy A.V., Kutishenko N.P., Kozminsky A.N., Moseichuk K.A., Pereverzeva K.G., Pravkina E.A., Belova E.N., Kudryashov E.V., Deev A.D. THE STUDY "REGISTER OF PATIENTS AFTER ACUTE STROKE (REGION)". PART 2. OUTPATIENT PROSPECTIVE REGISTER OF PATIENTS AFTER ACUTE STROKE (ACCORDING TO THE RESULTS OF THE PILOT PHASE OF THE STUDY). Rational Pharmacotherapy in Cardiology. 2017;13(1):4-17. (In Russ.) https://doi.org/10.20996/1819-6446-2017-13-1-4-17

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