Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Cardiovascular Diseases and Drug Treatment in Patients with the History of Cerebral Stroke: Data of the Outpatient Registry REGION

https://doi.org/10.20996/1819-6446-2018-14-6-870-878

Full Text:

Abstract

Aim. To evaluate the structure of combined cardiovascular diseases, drug treatment and observation of patients with a history of stroke in the framework of prospective outpatient registries. Material and methods. The study was conducted based on 3 outpatient clinics of Ryazan city. Patients with a history of acute cerebrovascular accident (ACVA) of any remoteness (AR) were included into ACVA-AR outpatient registry (n=511). Patients who had visited the outpatient clinics for the first time (FT) after cerebral stroke (n=475) were included into the ACVA-FT outpatient registry. The structure of the cardiovascular diseases (CVD), compliance with the clinical recommendations of the prescribed and received drug therapy were evaluated. The proportion of patients with dispensary observation for CVD, using preferential drug provision was determined. Results. A combination of 2 or more CVDs was found in 84.4% and 82.5% of cases, and severe cardiovascular multimorbidity (3-4 CVDs) – in 69% and 64% of cases, respectively, in ACVA-AR and ACVA-FT registers. Compliance with the clinical guidelines prescribed and received drug therapy was insufficient at the outpatient stage. Necessary prescription of drugs with a proven beneficial effect on the prognosis were observed significantly more frequent in the ACVA-FT registry, compared to the ACVA-AR registry at the enrolling stage of the study (p<0.05): statins for stroke – 50.1% vs 25.2%; statins for coronary heart disease (CHD) – 47.2% vs 27.9%; antiplatelet agents for CHD without atrial fibrillation – 65.6% vs 54.3%; anticoagulants for atrial fibrillation – 17.7% vs 9.3%; beta-blockers for heart failure 43.5% vs 33.1%, respectively. After 2-3 years of the follow-up frequency of prognostically significant prescriptions in patients of the compared registries were not significantly different, except prescriptions for statin therapy (47.6% vs 21.3%, respectively). The prognostically significant prescriptions during the enrolling stage in ACVA-AR and ACVA-FT registries occurred in 44.4% and 54% of the total number of proper prescriptions, and in the long-term follow-up period – in 55% and 57%, respectively; and the dispensary observation coverage was only 35.0% and 31.8%, respectively. According to patient contact only 21-24% of patients used the system of preferential drug provision at the stage of inclusion into the registers, and after 2-3 years of follow-up – 1.5-2 times less (12-14%). Conclusion The results of the study REGION found the presence of cardiovascular multimorbidity in 83% of patients with a history of stroke, insufficient quality of prescribed drug therapy in the out-patient clinic, especially in the ACVA-AR registry. The quality of medical treatment of patients improved within 2-3-year follow-up after the reference visit to out-patient clinic, but not sufficiently. Increase in dispensary observation coverage and optimization of the system of preferential drug provision are also important reserves for improving the quality of treatment of patients with a history of stroke, as well as prevention of cardiovascular complications.

 

About the Authors

M. M. Loukianov
National Medical Research Center for Preventive Medicine
Russian Federation
MD, PhD, Head of Department of Clinical Cardiology and Molecular Genetics


S. S. Yakushin
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation
MD, PhD, Professor, Head of Chair of Hospital Therapy


S. Yu. Martsevich
National Medical Research Center for Preventive Medicine
Russian Federation
MD, PhD, Professor, Head of Department of Preventive Pharmacotherapy


O. M. Drapkina
National Medical Research Center for Preventive Medicine
Russian Federation
MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director


A. N. Vorobyev
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation
MD, PhD, Assistant, Chair of Polyclinic Therapy and Preventive Medicine


A. V. Zagrebelnyy
National Medical Research Center for Preventive Medicine
Russian Federation
MD, PhD, Senior Researcher, Department of Preventive Pharmacotherapy


A. N. Kozminsky
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation
MD, PhD, Assistant, Simulation Training Center


K. A. Moseichuk
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation
MD, PhD, Assistant, Chair of Polyclinic Therapy and Preventive Medicine


K. G. Pereverzeva
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation
MD, PhD, Assistant, Chair of Hospital Therapy


E. A. Pravkina
Regional Clinical Cardiology Dispensary
Russian Federation
MD, PhD, Cardiologist


E. Yu. Okshina
National Medical Research Center for Preventive Medicine
Russian Federation
MD, PhD, Senior Researcher, Department of Clinical Cardiology and Molecular Genetics


E. V. Kudryashov
National Medical Research Center for Preventive Medicine
Russian Federation
programmer, Laboratory of biostatistics


E. N. Belova
National Medical Research Center for Preventive Medicine
Russian Federation
Programmer, Laboratory of Biostatistics


V. G. Klyashtorny
National Medical Research Center for Preventive Medicine
Russian Federation
PhD (in Biology), Researcher, Laboratory of Biostatistics


S. A. Boytsov
National Medical Research Centre of Cardiology
Russian Federation
MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, General Director


References

1. Benjamin E.J., Virani S.S., Callaway C.W. et al. Heart Disease and Stroke Statistics 2018 Update: A Report from the American Heart Association. Circulation. 2018;137:e67-e492. doi:10.1161/ CIR.0000000000000558.

2. Demographic Yearbook of Russia (2017). Statistical collection. Moscow: Rosstat; 2018 (In Russ.) [Демографический ежегодник России (2017). Статистический сборник. Москва: Росстат; 2018].

3. Meschia J.F., Bushnell C., Boden-Albala B. et al. Guidelines for the Primary Prevention of Stroke. Stroke. 2014;45(12):3754-832. doi:10.1161/STR.0000000000000046

4. Piepoli M.F., Hoes A.W., Agewall S. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016:37;2315-81. doi:10.1093/eurheartj/ehw106.

5. Kernan W.N., Ovbiagele B., Black H.R. et al. Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack. Stroke. 2014;45(7):2160-236. doi:10.1161/STR.0000000000000024.

6. Boytsov S.A., Pogosova N.V., Drapkina O.M. et al. Cardiovascular prevention (2017). Russian national recommendations. Russ J Cardiol. 2018;23(6):7-122. (In Russ.). doi:10.15829/1560-4071-2018-6-7-122.

7. Winstein C.J., Stein J., Arena R. et al. Guidelines for Adult Stroke Rehabilitation and Recovery. Stroke. 2016;47(6):e98-e169. doi:10.1161/STR.0000000000000098.

8. Yusuf S., Islam S., Chow C.K. et al. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey. Lancet. 2011;378(9798):1231-43. doi:10.1016/S0140-6736(11)61215-4.

9. Smith E.E., Saposnik G., Biesseet G.J. et al. Prevention of Stroke in Patients with Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017;48:e44-e7. doi:10.1161/STR. 0000000000000116.

10. Gierlotka M., Labuz-Roszak B., Wojtyniak B. et al. Early and One-Year Outcomes of Acute Stroke in the Industrial Region of Poland During the Decade 2006-2015: The Silesian Stroke Registry. Neuroepidemiology. 2018;50:183-94. doi:10.1159/000487324.

11. Amarenco P., Lavallée P.C., Monteiro T.L. et al. Five-Year Risk of Stroke after TIA or Minor Ischemic Stroke. The New England Journal of Medicine. 2018;378(23):2182-90. doi:10.1056/NEJMoa 1802712.

12. Ogawa H., Senoo K., An Y. et al. Clinical Features and Prognosis in Patients with Atrial Fibrillation and Prior Stroke: Comparing the Fushimi and Darlington AF Registries. EBioMedicine. 2017;18:199-203. doi:10.1016/j.ebiom.2017.03.022.

13. Boytsov S.A., Martsevich S.Y., Ginzburg M.L. et al. Lyubertsy study on mortality rate in patients after cerebral stroke or transient ischemic attack (LIS-2). Design and medical treatment estimation. Rational Pharmacotherapy in Cardiology. 2013;9(2):114-22. (In Russ.). doi:10.20996/1819-6446-2013-9-2-114-122.

14. Boytsov S.A., Lukyanov M.M., Yakushin S.S. et al. Outpatient register of cardiovascular diseases in the Ryazan Region (RECVASA): principal tasks, experience of development and first results. Cardiovascular Therapy and Prevention. 2014;13(6):44-50 (In Russ.). doi:10.15829/1728-8800-2014-6-3-8.

15. Andersson T., Magnuson A., Bryngelsson I.L. et al. Patients with atrial fibrillation and outcomes of cerebral infarction in those with treatment of warfarin versus no warfarin with references to CHA2DS2-VASc score, age and sex A Swedish nationwide observational study with 48433 patients. PLoS One. 2017;12(5):e0176846. doi:10.1371/journal.pone.0176846.

16. Skvortsova V.I., Shetova I.M., Kakorina E.P. et al. Reduction in stroke death rates through a package of measures to improve medical care for patients with vascular diseases in the Russian Federation. The Russian Journal of Preventive Medicine. 2018;21(1):4-10 (In Russ.) doi:10.17116/profmed20182114-10.

17. Chugunova S.A., Nikolaeva T.Y., Kuzmina Z.M. et al. Stroke epidemiology in Yakutsk based on the population-based register in 2015. Far East Medical Journal. 2017;3:80-5 (In Russ.)

18. Khutieva L.S., Efremov V.V. Clinical and epidemiological characteristics and stroke risk factors in Ingushetia. New Technologies. 2012;1:234-9 (In Russ.)

19. Suvorov A.Y., Martsevich S.Y., Kutishenko N.P. et al. Evaluation of compliance with modern clinical recommendations of cardiovascular therapy aimed at improving outcomes in patients after a stroke (according to the LIS-2 registry). Rational Pharmacotherapy in Cardiology. 2015;11(3):247-52 (In Russ.). doi:10.15829/1560-4071-2015-6-14-19.

20. Suvorov A.Y., Martsevich S.Y., Kutishenko N.P. et al. Evaluation of the quality of therapy in the registries of acute cerebral circulation disorders. Foreign eхperience, the prospects of Russia. Kardiovaskularnaya Terapiya i Profilaktika. 2014;13(4):81-6 (In Russ.) doi:10.15829/1728-8800-2014-4-81-86.

21. Boytsov S.A., Martsevich S.Y., Kutishenko N.P. et al. The study “Register of Patients after Acute Stroke (REGION)”. Part 1. Hospital Prospective Register of Patients after Acute Stroke (According to the Results of the Pilot Phase of the Study). Rational Pharmacotherapy in Cardiology. 2016;12(6):645-53 (In Russ.) doi: 10.20996/1819-6446-2016-12-6-645-653.

22. Boytsov S.A., Lukyanov M.M., Yakushin S.S. et al. The study “Register of Patients after Acute Stroke (REGION)”. Outpatient Prospective Register of Patients after Acute Stroke Part 2. (According to the Results of the Pilot Phase of the Study). Rational Pharmacotherapy in Cardiology. 2017;13(1):4-17 (In Russ.) doi:10.20996/1819-6446-2016-12-6-645-653.

23. Boytsov S.A., Loukianov M.M., Yakushin S.S. et al. Drug treatment of patients with the history of acute stroke: Data of the pilot phase of the outpatient registry “REGION”. Rational Pharmacotherapy in Cardiology. 2017;13(3):346-56 (In Russ.) doi:10.20996/1819-6446-2017-13-1-4-17.


For citation:


Loukianov M.M., Yakushin S.S., Martsevich S.Y., Drapkina O.M., Vorobyev A.N., Zagrebelnyy A.V., Kozminsky A.N., Moseichuk K.A., Pereverzeva K.G., Pravkina E.A., Okshina E.Y., Kudryashov E.V., Belova E.N., Klyashtorny V.G., Boytsov S.A. Cardiovascular Diseases and Drug Treatment in Patients with the History of Cerebral Stroke: Data of the Outpatient Registry REGION. Rational Pharmacotherapy in Cardiology. 2018;14(6):879-886. https://doi.org/10.20996/1819-6446-2018-14-6-870-878

Views: 114


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)