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ASSESSMENT OF ADHERENCE TO TREATMENT AND FACTORS AFFECTING IT IN PATIENTS WITH STABLE ISCHEMIC HEART DISEASE DURING THERAPY WITH NICORANDIL

https://doi.org/10.20996/1819-6446-2017-13-6-776-786

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Abstract

Working Group of the NIKEA Program. Ekaterinburg: Akulina E.N.; Izhevsk: Shinkareva S. E., Grebnev S.A.; Krasnodar: Kudryashov E.A., Fendrikova A.V.; Krasnoyarsk: Nemik D.B., Pitaev R.R., Altaev V.D., Samokhvalov E.V., Stolbikov Y.Y.; Moscow: Dmitrieva N.A., Zagrebelnyy A.D., Zakharova A.V., Balashov I.S., Leonov A.S., Sladkova T.A., Zelenova T.I., Shestakova G.N., Kolganova E.V., Maksimova M.A.; Novosibirsk: Moskalenko I.V., Shurkevich A.A.; Omsk: Loginova E.N., Gudilin V.A.; Orel: Zhuravleva L.L., Lobanova G.N., Luneva M.M.; Orenburg: Kondratenko V.Y.; Rostov-on-Don: Kalacheva N.M., Kolomatskaia O.E., Dubishcheva N.F., Romadina G.V., Chugunova I.B., Skarzhinskaia N.S.; Ryazan: Bulanov A.V., Trofimova Y.M., Nikolaeva A.S.; St. Petersburg: Savinova E.B., Ievskaia E.V., Vasileva L.B.; Tula: Zubareva L.A., Berberfish L.D., Gorina G.I., Nadezhkina K.N., Iunusova K.N., Nikitina V.F., Dabizha V.G., Renko I.E., Soin I.A.

Aim. To study the adherence to treatment and the factors that affect it in patients with stable coronary heart disease during the treatment with nicorandil. Material and methods. The use of nicorandil in addition to standard antianginal therapy was recommended to patients (n=590) in a prospective, observational, multicenter NIKEA study. Patients completed original questionnaires on adherence, including a Morisky-Green test at the enroll visit. The questionnaires were filled by 423 patients (73% response). The factors that influence adherence were studied.

Results. All patients were divided into 3 groups, depending on the adherence to the use of nicorandil: immediately refused to take the drug (n=150; group 1); started, but stopped taking nicorandil in the first 3 months of observation (n=75; group 2); who took nicorandil for 3 months (n=327; group 3). Potentially adherents (intention to treat) were 582 out of 590 (98.6%) patients, and actually adherents – only 327 of 552 (59.2%) patients. The main reason for non-adherence to the beginning of therapy is polypharmacy; to the continuation of the treatment that had just started – adverse events; for termination of long-term therapy – polypharmacy, adverse events and insufficient effectiveness of treatment. Group 3 had initially more severe angina pectoris: more number of angina attacks (p=0.014) and the need of short-acting nitrates (p<0.0001). Patients of the group 1 compared to the patients of group 3 did not visit the doctors more often or attended them only when necessary, violated the medical prescriptions for taking medications (p<0.05). According to the results of the Morisky-Green test, 150 patients (36.2%) were not are committed to medical recommendations, 264 (63.8%) – are committed. Women were more adherent than men (p=0.47); patients with class I angina were more adherent than patients with class III angina (p=0.027), and patients who regularly attended the treating physician (more often than once a month) were more committed to medical recommendations than patients, not visiting the treating physician (p=0.004).

Сonclusion. The levels of overall adherence according to Morisky-Green test, the potential adherence according to the survey and the actual adherence of patients to treatment vary considerably. The leading cause of non-adherence at the beginning of therapy is polypharmacy, for the continuation of the recently started treatment – the adverse events; for long-term sustained treatment – equally polypharmacy, drug adverse events and the lack of treatment efficacy.

About the Authors

S. Yu. Martsevich
National Medical Research Center for Preventive Medicine
Russian Federation

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

Petroverigsky per. 10, Moscow, 101990



Yu. V. Lukina
National Medical Research Center for Preventive Medicine
Russian Federation

Yulia V. Lukina – MD, PhD, Leading Researcher, Department of Preventive Pharmacotherapy 

Petroverigsky per. 10, Moscow, 101990



N. P. Kutishenko
National Medical Research Center for Preventive Medicine
Russian Federation

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

Petroverigsky per. 10, Moscow, 101990



A. V. Akimova
National Medical Research Center for Preventive Medicine
Russian Federation

Anna V. Akimova – MD, Junior Researcher, Laboratory for Pharmacoepidemiological Studies, Department of Preventive Pharmacotherapy 

Petroverigsky per. 10, Moscow, 101990



V. P. Voronina
National Medical Research Center for Preventive Medicine
Russian Federation

Viktoria P. Voronina – MD, PhD, Senior Researcher, Department of Preventive Pharmacotherapy 

Petroverigsky per. 10, Moscow, 101990



O. V. Lerman
National Medical Research Center for Preventive Medicine
Russian Federation

Olga V. Lerman – MD, PhD, Senior Researcher, Department of Preventive Pharmacotherapy 

Petroverigsky per. 10, Moscow, 101990



O. V. Gaisenok
Joint Hospital and Polyclinic, Administrative Department of the President of the Russian Federation
Russian Federation

Oleg V. Gaisenok – MD, PhD, Head of Department of General Cardiology 

Michurinskiy prosp. 6, Moscow, 119285 



T. A. Gomova
Tula Regional Clinical Hospital
Russian Federation

Tatyana A. Gomova – MD, PhD, Deputy Chief Physician on General Issues 

Yablochkova ul. 1а, Tula, 300053 



A. V. Ezhov
Izhevsk State Medical Academy
Russian Federation

Andrey V. Ezhov – MD, PhD, Professor, Chair of General Practitioner and Internal Medicine with the Course of Emergency Medical Care 

Kommunarov ul. 281, Izhevsk, Republic of Udmurtia, 426034



A. D. Kuimov
Novosibirsk State Medical University
Russian Federation

Andrey D. Kuimov – MD, PhD, Professor, Head of Chair of Faculty Therapy 

Krasnii pr. 52, Novosibirsk, 630091 



R. A. Libis
Orenburg State Medical University
Russian Federation

Roman A. Libis – MD, PhD, Professor, Head of Chair of Hospital Therapy 

Sovetskaya ul. 6, Orenburg, 460000 



G. V. Matyushin
Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky
Russian Federation

Gennady V. Matyushin – MD, PhD, Professor, Head of Chair of Cardiology and Functional Diagnostics 

Partizana Zheleznyaka ul. 1, Krasnoyarsk, 660022 



T. N. Mitroshina
Out-patient Clinic №3
Russian Federation

Tatyana N. Mitroshina – MD, Cardiologist 

Komsomolskaya ul. 32, Orel, 302001 



G. I. Nechaeva
Omsk State Medical University
Russian Federation

Galina I. Nechaeva – MD, PhD, Professor, Head of Chair of Internal Medicine and Family Medicine 

Lenina ul. 12, Omsk, 644099 



I. I. Reznik
Ural State Medical University
Russian Federation

Inna I. Reznik – MD, PhD, Professor, Chair of Therapy, Faculty of Advanced Studies and Postgraduate Training of Doctors 

Repina ul. 3, Ekaterinburg, 620014 



V. V. Skibitsky
Kuban State Medical University
Russian Federation

Vitaliy V. Skibitsky – MD, PhD, Professor, Head of Chair of Hospital Therapy 

Mitrofana Sedina ul. 4, Krasnodar, 350063 



L. A. Sokolova
Almazov National Medical Research Center
Russian Federation

Lyudmila A. Sokolova – MD, PhD, Professor, Leading Researcher, Research Laboratory of Preventive Cardiology 

Akkuratova ul. 2, St. Petersburg, 197341 



A. I. Chesnikova
Rostov State Medical University
Russian Federation

Anna I. Chesnikova – MD, PhD, Professor, Chair of Internal Medicine №1 

Suvorova ul. 119, Rostov-on-Don, 344022 



N. V. Dobrynina
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation

Natalia V. Dobrynina – MD, PhD, Assistant, Chair of Hospital Therapy 

Visokovoltnaya ul. 9, Ryazan, 390026



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

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

Visokovoltnaya ul. 9, Ryazan, 390026



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For citation:


Martsevich S.Y., Lukina Y.V., Kutishenko N.P., Akimova A.V., Voronina V.P., Lerman O.V., Gaisenok O.V., Gomova T.A., Ezhov A.V., Kuimov A.D., Libis R.A., Matyushin G.V., Mitroshina T.N., Nechaeva G.I., Reznik I.I., Skibitsky V.V., Sokolova L.A., Chesnikova A.I., Dobrynina N.V., Yakushin S.S. ASSESSMENT OF ADHERENCE TO TREATMENT AND FACTORS AFFECTING IT IN PATIENTS WITH STABLE ISCHEMIC HEART DISEASE DURING THERAPY WITH NICORANDIL. Rational Pharmacotherapy in Cardiology. 2017;13(6):776-786. (In Russ.) https://doi.org/10.20996/1819-6446-2017-13-6-776-786

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