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Outpatient Registry REGION: Prospective Follow-up Data and Outcomes in Patients After Acute Cerebrovascular Accident

https://doi.org/10.20996/1819-6446-2019-15-6-847-853

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Abstract

Aim. To estimate outcomes and risk of all-cause mortality, cardiovascular (CV) mortality, and non-fatal CV events in patients with a history of acute cerebrovascular accident (ACVA) according to data of outpatient prospective registries.

Material and methods. 986 patients with a history of ACVA (aged 70.6Ѓ}10.9 years; 56.8% women) were enrolled into the outpatient registry REGION-Ryazan, including the registry of patients with ACVA of any remoteness (ACVA-AR) – 511 (aged 70.4Ѓ}10.5 years; 58.5% women) and the registry of patients, visited outpatient clinics for the first time after ACVA (ACVA-FT) – 475 (aged 70.8Ѓ}11.3 years; 54.9% women). Outcomes, risk of all-cause and CV mortality, composite CV endpoint (CV death, nonfatal myocardial infarction and ACVA), hospitalizations due to CV diseases (CVD) were evaluated during 37 (17;52) months of follow-up period.

Results. 310 (31.2%) patients died during the follow-up. The most part of fatal outcomes (56.4%) was registered during the first year of follow-up, especially during the first 3 months (33.9%). Mortality among men (35.9%) was higher than among women (28.0%), р=0.008. 147 (28.8%) and 163 (34.3%) patients died in registries ACVA-AR and ACVA-FT, respectively (70.4% and 90.2% of fatal outcomes were from CV causes, respectively; р=0.04). The higher risk of death was associated with the following factors: age – hazard ratio (HR) 1.10 for each next year of age (95% confidence interval [95%CI] 1.09-1.12); sex (men) – HR 2.01 (95%CI 1.55-2.62); atrial fibrillation (AF) – HR 1.42 (95%CI 1,09-1,86); recurrent ACVA – HR 1.64 (95%CI 1.23-2.19); history of myocardial infarction (MI) – HR 1.45 (95%CI 1.09-1.93); low blood hemoglobin level – HR 2.44 (95%CI 1.59-3.79); heart rate ≥80 beats/min – HR 1.51 (95%CI 1.13-2.03); diabetes – HR 1.56 (95%CI 1.16-2.08); chronic obstructive pulmonary disease (COPD) – HR 1.89 (95%CI 1.34-2.66); no antihypertensive therapy in arterial hypertension – HR 2.03 (95%CI 1.42-2.88). The lower risk of death was associated with the following factors: prescription of ACE inhibitors (ACEI) – HR 0.60 (95%CI 0.42-0.85); angiotensin II receptor blockers (ARB) – HR 0.26 (95%CI 0.13-0.50), beta-blockers – HR 0.71 (95%CI 0.50-0.99); statins – HR 0.59 (95%CI 0.42-0.82). Factors, listed above, had significant association not only with all-cause mortality but also with CV mortality and composite CV endpoint. The higher rate of hospitalizations due to CVD was associated with younger age (incidence rate ratio [IRR] for 1 year 1.03; 95%CI 1.02-1.05; р<0.001), female sex (IRR 2.40; 95%CI 1.79-3.23; р<0.001), COPD (IRR 2.44; 95%CI 1.63-3.65; р<0.001) and heart rate ≥80 beats/min (IRR 1.51; 95%CI 1.12-2.04; р=0.007).

Conclusions. All-cause mortality in patients with a history of ACVA, enrolled in outpatient registry REGION, was 31.2% during 3-year follow-up. The proportion of CV death among the fatal cases was higher in the ACVA-FT registry than in ACVA-AR registry. The higher mortality rate was associated with the following factors: age, sex (male), recurrent ACVA, history of MI, diagnosis of AF, COPD and diabetes, low blood hemoglobin level, heart rate ≥80 beats/min, no antihypertensive therapy in arterial hypertension. The higher incidence of hospitalizations due to CVD was associated with younger age, sex (female), COPD and heart rate ≥80 beats/min. Prescription of ACEI, ARB, beta-blockers and statins was associated with lower risk of death and composite CV endpoint.

About the Authors

M. M. Loukianov
National Medical Research Center for Preventive Medicine
Russian Federation

Mikhail M. Loukianov – MD, PhD, Head of Department of Clinical Cardiology and Molecular Genetics

Petroverigsky per. 10, Moscow, 101990



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

Vysokovoltnaya ul. 9, Ryazan, 390026



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



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

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

Vysokovoltnaya ul. 9, Ryazan, 390026



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

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

Vysokovoltnaya ul. 9, Ryazan, 390026



E. Yu. Okshina
National Medical Research Center for Preventive Medicine
Russian Federation

Elena Yu. Okshina – MD, PhD, Senior Researcher, Department of Clinical Cardiology and Molecular Genetics

Petroverigsky per. 10, Moscow, 101990



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

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

Petroverigsky per. 10, Moscow, 101990



V. G. Klyashtorny
National Medical Research Center for Preventive Medicine
Russian Federation

Vladislav G. Klyashtorny – PhD (in Biology), Researcher

Petroverigsky per. 10, Moscow, 101990



E. V. Kudryashov
National Medical Research Center for Preventive Medicine
Russian Federation

Egor V. Kudryashov – Programmer, Laboratory of Biostatistics

Petroverigsky per. 10, Moscow, 101990



S. A. Boytsov
National Medical Research Center of Cardiology
Russian Federation

Sergey A. Boytsov – MD, PhD, Professor, Academician of the Russian Academy of Sciences, General Director

Tretya Cherepkovskaya ul. 15а, Moscow, 121552



O. M. Drapkina
National Medical Research Center for Preventive Medicine
Russian Federation

Oxana M. Drapkina – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director

Petroverigsky per. 10, Moscow, 101990



References

1. Benjamin E.J., Muntner P., Alonso A., et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56-e528. DOI:10.1161/CIR.0000000000000659/

2. 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.

3. Liao Y., Greenlund K.J., Croft J.B., et al. Factors explaining excess stroke prevalence in the US Stroke Belt. Stroke. 2009;40(10):3336-41. DOI:10.1161/STROKEAHA.109.561688.

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:10.15829/15604071-2018-6-7-122.

7. Boytsov S.A., Martsevich S.Y., Kutishenko N.P., et al. Registers in cardiology: their principles, rules, and real-word potential. Cardiovascular Therapy and Prevention. 2013;12(1):4-9 (In Russ.) DOI:10.15829/1728-8800-2013-1-4-9.

8. 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:10.20996/1819-6446-2015-113-247-252.

9. 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;3:80-85. (In Russ.)

10. Boytsov S.A., Lukyanov M.M., Yakushin S.S., et al. The outpatient based registry RECVASA: prospective follow-up data, risk evluation and outcomes in cardiovascular patients. Cardiovascular Therapy and Prevention. 2015;14(1):53-62 (In Russ.) DOI:10.15829/1728-8800-2015-1-53-62.

11. Loukianov M.M., Yakushin S.S., Martsevich S.Y., et al. Cardiovascular Diseases and Drug Treatment in Patients with the History of Cerebral Stroke: Data of the Outpatient Registry REGION. Ration Pharmacother Cardiol. 2018;14(6):879-86 (In Russ.). DOI:10.20996/18196446-2018-14-6-879-886.

12. Martsevich S.Y., Kutishenko N.P., Lukyanov M.M., et al. The study Hospital register of patients with acute cerebrovascular accident (REGION): characteristics of patient and outcomes of hospital treatment. Cardiovascular Therapy and Prevention. 2018;17(6):32-8 (In Russ.). DOI:10.15829/1728-8800-2018-6-32-38.

13. Cabral N.L., Muller M., Franco S.C., et al. Three-year survival and recurrence after first-ever stroke: The Joinville stroke registry. BMC Neurol. 2015;15:70. DOI:10.1186/s12883-015-0317-1.

14. Elneihoum A.M., Goransson M.., Falke P, et al. Three-year survival and recurrence after stroke in Malmo, Sweden: an analysis of stroke registry data. Stroke. 1998;29:2114-17. DOI:10.1161/01.str.29.10.2114.

15. Phan H.T., Blizzard C.L., Reeves M.J., et al. Sex Differences in Long-Term Mortality After Stroke in the INSTRUCT (INternational STRoke oUtComes sTudy). Circ Cardiovasc Qual Outcomes. 2017;10:e003436. DOI:10.1161/CIRCOUTCOMES.116.003436.

16. Radisauskas R., Tamosiunas A., Kranciukaite-Butylkiniene D., et al. Long-term survival after stroke in Lithuania: Data from Kaunas population-based stroke registry. PLoS ONE. 2019;14(7):e0219392. DOI:10.1371/journal.pone.0219392.

17. Takashima N., Arima H., Kita Y., et al. Incidence, Management and Short-Term Outcome of Stroke in a General Population of 1,4 Million Japanese. Circ J. 2017;81:1636-46. DOI:10.1253/circj.CJ17-0177.

18. Andersen K.K., Olsen T.S. Social Inequality by Income in Shortand Long-Term Cause-Specific Mortality after Stroke. Journal of Stroke and Cerebrovascular Diseases. 2019;28(6):1529-36. DOI:10.1016/j.jstrokecerebrovasdis.2019.03.013.

19. 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/S01406736(11)61215-4.

20. Rector T.S., Vickrey B.G., Wickstrom S.L., et al. Occurrence of Secondary Ischemic Events Among Persons With Atherosclerotic Vascular Disease. Stroke. 2002;33:901-6 DOI:10.1161/hs0402.105246.

21. Emdin C.A., Rothwell P.M., Salimi-Khorshidi G., et al. Blood pressure and risk of vascular dementia: evidence from a primary care registry and a cohort study of transient ischemic attack and stroke. Stroke. 2016;47:1429-35 DOI:10.1161/STROKEAHA.116.012658.

22. Goldstein L.B., Amarenco P., Lamonte M., et al.; on behalf of the SPARCL Investigators. Relative effects of statin therapy on stroke and cardiovascular events in men and women: secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Study. Stroke. 2008;39:2444-8. DOI:10.1161/STROKEAHA.107.513747.


For citation:


Loukianov M.M., Yakushin S.S., Martsevich S.Y., Vorobyev A.N., Pereverzeva K.G., Okshina E.Y., Zagrebelnyy A.V., Klyashtorny V.G., Kudryashov E.V., Boytsov S.A., Drapkina O.M. Outpatient Registry REGION: Prospective Follow-up Data and Outcomes in Patients After Acute Cerebrovascular Accident. Rational Pharmacotherapy in Cardiology. 2019;15(6):847-853. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-6-847-853

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