Rational Pharmacotherapy in Cardiology

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Aim. To assess the quality of drug therapy and its correspondence with current clinical guidelines in patients with proven stable ischemic heart disease (IHD) before admission, during inpatient stay in hospital and after hospital discharge.
Material and methods. Data on 550 patients (from PROGNOZ IBS register) with detected stenosis of at least one coronary artery ≥50% were included in the analysis. Assessment of the quality of drug therapy was conducted in patients who made a follow-up visit in 3.9 years after the reference hospitalization (n=303) using a specially designed questionnaire. Adherence to treatment was studied using a phone survey.
Results. According to PROGNOZ IBS register data we revealed low prescription frequency of drugs with proven effects on the cardiovascular risk in patients with stable IHD prior to hospital admission and significant pharmacotherapy improvement in specialized cardiology hospital. In specialized hospital the rate of aspirin use increased by 30%, statins - by 80%, beta-blockers - by 70%, ACE inhibitors - by 60% (p<0.0001). These medications prescription frequency decreased by 15-20% on the average in 3.9 years after discharge.
Conclusion. We found significant improvement in pharmacotherapy quality of patients with stable IHD during stay in cardiology hospital, and pharmacotherapy quality reduction after discharge.

About the Authors

S. N. Tolpygina
State Research Center for Preventive Medicine, Moscow
Russian Federation

Yu. N. Polyanskaya
State Research Center for Preventive Medicine, Moscow
Russian Federation

S. Yu. Martsevich
State Research Center for Preventive Medicine, Moscow
Russian Federation


1. World Health Organization. Preventing chronic diseases: A vital investment. Available at:

2. Demographic Yearbook of Russia, 2010. Statistical Compendium. Moscow: Rosstat, 2010. Russian (Демографический ежегодник России, 2010. Статистический Сборник. М.: Росстат; 2010)

3. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokianse, oral aspirin, both, or neither among 17187 cases of suspected acute myocardial infarction: ISIS02. Lancet 1988; 332: 349-60.

4. ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group: ISIS-4. A randomized factorial trial assessing early oral captopril, oral mononitrate and intravenous magnesium sulphate in 58050 patients with suspect acute myocardial infarction. Lancet 1995; 346: 669-85.

5. Scandinavian Simvastatin Survival Study Group: Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: The Scandinavian Simvastatin Survival Study. Lancet 1994: 344: 1383-9.

6. Schomig A., Neumann F. J., Kastrati A., et al. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. (ISAR). N Engl J Med 1996;334: 1084-9.

7. Sever PS, Dahlof B, Poulter NR, et al for the ASCOT investigators. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial – Lipid Lowering Arm (ASCOT-LLA): a multicentre randomized controlled trial. Lancet 2003; 361: 1149-58.

8. Sever PS, Poulter NR, Dahlof B, et al. Different time course for prevention of coronary and stroke events by atorvastatin in the Anglo-Scandinavian Cardiac Outcomes Trial-Lopid-Lowering Arm (ASCOT-LLA). Am J Cardiol 2005; 96 (5 suppl): 39-44F.

9. Dahlof B, Sever PS, Poulter NR, et al. Prevention of cardiovascular events with an attihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): A multicentre randomised controlled trial. Lancet 2005; 366: 895-906.

10. Shepherd L, Blauw GJ, Murphy MB, et al. PROSPER study group. PROspective study of pravastatin in the elderly at risk. Pravastatin in elederly individuals at risk vascular disease (PROSPER): a randomised controlled trial. Lancet 2002: 360; 1623-30.

11. Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996; 348:1329-39.

12. Stevens VJ, Obarzanek E, Cook NR, et al. Trials of Hypertension Prevention-II. Ann Intern Med 2001; 134: 1-11.

13. Swedberg K, Held P, Kjekshus J et al. Effects of early administration of enalapril on mortality in patients with acute myocardial infarction. Results of Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II). N Engl J Med 1992;327:678-84.

14. The Acute Infarction Ramipril Effiicacy (AIRE) Study Investigators: effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993; 342: 821-5.

15. The BHAT research group. A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA 1982; 247:1707-14.

16. The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. New Engl J Med 2001; 345: 494-502.

17. The coronary heart disease risk map of Europe. The 1-st Report of the WHO ERICA Project. Eur Heart J 1988; 9 (Suppl 1): 1-36.

18. The EURopean trial On reduction of cardiac events whit Perindopril in stable coronary Artery disease investigators. Efficacy of perindoprili in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EU- ROPA study). Lancet 2003; 362(9386): 782-8.

19. The Heart Outcomen Prevention Evaluation Study investigators. Effects of angiotensin-convertingenzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342(3): 145-53.

20. The Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339:1349-55.

21. Pfeffer MA, Braunwald E, Moye LA et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the survival and ventricular enlargement trial the SAVE Investigators. N Engl J Med 1992; 327: 669-77.

22. Pfeffer MA, McMurray J, Leizorovicz A, et al. Valsartan in acute myocardial infarction trial (VALIANT): rationale and design. Am Heart J 2000;140(5):727-50.

23. Yusuf S, Hawken S, Ounpuu S et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937-52.

24. 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.

25. Oganov RG, Pogosova GV, Koltunov IE, et al. RELIF – Regular Treatment And prevention – a key to situation improvement with cardiovascular diseases in Russia: results Russian multicenter research. Part I. Cardiology 2007; 47(5): 58-66. Russian (Оганов Р.Г., Погосова Г.В., Колтунов И.Е., и др. РЕЛИФ – Регулярное Лечение И проФилактика – ключ к улучшению ситуации с сердечно-сосудисты- ми заболеваниями в России: результаты российского многоцентрового исследования Часть I. Кардиология 2007; 47(5): 58-66).

26. Oganov RG, Pogosova GV, Koltunov IE et al. RELIF – Regular Treatment And prevention – a key to situation improvement with cardiovascular diseases in Russia: results of the Russian multicenter research Part II. Cardiology 2007; 47(11): 30-9. Russian (Оганов Р.Г., Погосова Г.В., Колтунов И.Е., и др. РЕЛИФ – Регулярное Лечение И проФилактика – ключ к улучшению ситуации с сердечно-сосудистыми заболеваниями в России: результаты российского многоцентрового исследования Часть II. Кардиология 2007; 47(11): 30-9).

27. Oganov RG, Pogosova GV, Koltunov IE et al. RELIF – Regular Treatment And prevention – a key to situation improvement with cardiovascular diseases in Russia: results of the Russian multicenter research. Part III. Cardiology 2008; 48(4): 46-53. Russian (Оганов Р.Г., Погосова Г.В., Колтунов И.Е., и др. РЕЛИФ – Регулярное Лечение И проФилактика – ключ к улучшению ситуации с сердечно-сосудистыми заболеваниями в России: результаты российского многоцентрового исследования. Часть III. Кардиология 2008; 48(4): 46-53).

28. Oganov R.G., Fitilev SB, Lepahin VK, et al. Assessment of implementation of recommendations about secondary prevention of cardiovascular diseases at the patients who have had a myocardial infarction. Cardiovascular Therapy and Prevention 2009; 8(4):71-5. Russian (Оганов Р.Г., Фитилев С,Б., Лепахин В.К., и др. Оценка выполнения рекомендаций по вторичной профилактике сердечно-сосудистых заболеваний у пациентов, перенесших инфаркт миокарда. Кардиоваскулярная Терапия и Профилактика 2009;8(4):71-5).

29. Susekov AV, Zubareva MYu, Deev AD, et al. Main results of the Moscow Research on Statines (to Moscow Statin Survey, MSS). Serdce 2006; (6): 324-8. (Сусеков А.В., Зубарева М.Ю., Деев А.Д и др. Основные результаты Московского Исследования по Статинам (Moscow Statin Survey, MSS). Серд- це 2006;(6): 324-8).

30. Martsevich SYu, Oganisyan NS, Dmitrieva NA, Klimakov AV. Condition of diagnostics and treatment of an arterial hypertension according to poll of doctors of Volgograd and the Volgograd region. Ra-tional Pharmacother Card 2005; (2):32-6. Russian (Марцевич С.Ю., Оганисян Н.С., Дмитриева Н.А., Климаков А.В. Состояние диагностики и лечения артериальной гипертонии по данным опроса врачей Волгограда и Волгоградской области. Рациональная Фармакотерапия в Кардиологии 2005;(2):32-6).

31. Oganisyan NS, Dmitrieva NA, Cochetkov AM, Martsevich SYu. Features of diagnosis and secondary prevention of arterial hypertension in a survey of physicians. Rational Pharmacother Card 2006; (2): 37-43. Russian (Оганисян Н.С., Дмитриева Н.А., Кочетков А.М., Марцевич С.Ю. Особенности диагностики и вторичной профилактики артериальной гипертонии по результатам опроса врачей. Рациональная Фармакотерапия в Кардиологии 2006; (2): 37-43).

32. Oganov R.G., Maslennikova G.Y. Cardiovascular diseases in the Russian Federation in the second half of the 20th century: tendencies, possible reasons, prospects. Cardiology 2000; (6):4-8. Russian (Оганов Р.Г., Масленникова Г.Я. Сердечно-сосудистые заболевания в Российской Федерации во второй половине 20 столетия: тенденции, возможные причины, перспективы // Кардиология 2000; (6): 4-8).

33. Neutel J.M., Smith D.H. Improving patient compliance: a major goal in the management of hypertension. J Clin Hypertens (Greenwich) 2003; 5(2):127-32.

34. Leibovitz E, Hertsog D, Oren S, et al. Lack of treatment continuance: an obstacle for controlling blood pressure. Harefuah 2005; 144(7): 467-70.

35. Chabot I, Moisan J, Gregoire J.P, et al. Pharmacist intervention program for control of hypertension. Ann Pharmacother 2003; 37(9): 1186-93.

36. Shalnova SA, Deev AD, Karpov YuA. Arterial hypertension and coronary heart disease in real practice of the cardiologist. Cardiovascular Therapy and Prevention 2006; 5(2): 73-80. Russian (Шальнова С.А., Деев А.Д., Карпов Ю.А. Артериальная гипертония и ишемическая болезнь сердца в реальной практике врача-кардиолога. Кардиоваскулярная Терапия и Профилактика 2006; 5(2): 73-80).

37. Shalnova SA, Deev AD. "Research lessons the OSCAR – epidemiology and features of therapy of patients of high risk in real clinical practice 2005-2006". Cardiovascular therapy and prevention 2007; 6(1):47-53. Russian (Шальнова С.А., Деев A.Д. «Уроки исследования ОСКАР – эпидемиология и особенности терапии пациентов высокого риска в реальной клинической практике 2005-2006 г». Кардиоваскулярная Терапия и Профилактика 2007; 6(1):47-53).

38. Shalnova SA, Deev AD, Vikhireva OV. Arterial hypertension eyes of ambulatory patients. First results of the research GARANT. Cardiovascular Therapy and Prevention 2007; 6(5):30-3. Russian (Шальнова С.А., Деев А.Д., Вихирева О.В. Артериальная гипертония глазами амбулаторных пациентов. Первые результаты исследования ГАРАНТ. Кардиоваскулярная Терапия и Профилактика 2007;6(5):30-3.)

39. Gofman EA, Martsevich SYu, Deev AD, et al. First results of the study CHD PROGNOSIS. Clinicist 2012; (1):58-64. Russian (Гофман Е.А., Марцевич С.Ю., Деев А.Д., и дрю. Первые результаты исследования ПРОГНОЗ ИБС. Клиницист 2012;(1):58-64.

40. Tolpygina SN, Martsevich SYu, Gofman EA, et al. The study "CHD PROGNOSIS" – experience of cre- ation of the register for an assessment of outcomes of chronically proceeding CHD. Cardiovascular Therapy and Prevention 2013;(1):32-9. Russian (Толпыгина С.H., Марцевич С.Ю., Гофман Е.А., Малышева А.М., и др. Исследование «ПРОГНОЗ ИБС» – опыт создания регистра для оценки исходов хронически протекающей ИБС. Кардиоваскулярная Терапия и Профилактика 2013;(1):32-9).

41. National guidelines for the diagnosis and treatment of stable angina. Cardiovaskular Therapy and Prevention 2008; 7(6) suppl 4: 1-45. Russian (Национальные рекомендации по диагностике и лечению стабильной стенокардии. Кардиоваскулярная Терапия и Профилактика 2008; 7(6) Приложение 4: 1-45.

42. Panchenko EP, Belenkov YuN. The characteristic and outcomes aterotrombosis at outpatients in the Russian Federation (on materials of the international register REACH). Cardiology 2008;(2):17-24. Russian (Панченко Е.П., Беленков Ю.Н. Характеристика и исходы атеротромбоза у амбулаторных больных в Российской Федерации (по материалам международного регистра REACH). Кардиология 2008; (2): 17-24).

43. EUROASPIRE I and II Group. Clinical realty of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. Lancet 2001; 357: 995-1001.

44. Kotseva K, Wood D, De Backer G, et al. EUROASPIRE III: A survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from twenty-two European countries. Eur J Cardiovasc Prev Rehabil 2009; 16(2):121-37.

45. Oganov RG, Lepakhin VK, Fitilev SB et al. Features of diagnostics and therapy of stable stenocardia in the Russian Federation (the international research ATP – Angina Treatment Pattern). Cardiology 2003; (5): 9-15. Russian (Оганов Р.Г., Лепахин В.К., Фитилев С.Б.. и др. Особенности диагностики и терапии стабильной стенокардии в Российской Федерации (международное исследование ATP – Angina Treatment Pattern). Кардиология 2003; (5): 9-15).

46. Aronov DM. How effectively to apply statines. Medical Council 2007; (1): 41-45 (Аронов Д.М. Как эффективно применять статины. Мед Совет 2007; (1): 41-45).

47. Ho MP, Peterson ED, Wang L, et al. Incidence of Death and Acute Myocardial Infarction Associated With Stopping Clopidogrel After Acute Coronary Syndrome. JAMA 2008; 299(5):532-9.

48. McFadden EP, Stabile E, Regar E, et al. Late thrombosis in Drug-Eluting Coronary Stents discontinuation of antiplatelet therapy. Lancet 2004; 364: 1519-21.

49. Schulz S, Schuster T, Mehili J, et al. Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period. Eur Heart J 2009;30(32):2714-21.

50. Grines CL, Bonow RO, Casey DE Jr, et al. Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents: A Science Advisory From the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American College of Physicians. Circulation 2007;115:813-8.

For citation:

Tolpygina S.N., Polyanskaya Yu.N., Martsevich S.Yu. TREATMENT OF PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE IN REAL CLINICAL PRACTICE ACCORDING TO THE DATA FROM PROGNOZ IBS REGISTER (PART 2). Rational Pharmacotherapy in Cardiology. 2013;9(5):494-499. (In Russ.)

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