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The Role of Adherence to Basic Pharmacotherapy of Heart Failure for Prevention of Late Adverse Events in Patients with Coronary Artery Disease and Left Ventricular Dysfunction After Surgical Revascularization of Myocardium

https://doi.org/10.20996/1819-6446-2020-10-04

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Abstract

Aim. To determine the role of adherence to the basic drug treatment of heart failure (HF) in prevention of late major adverse events (MAEs) after isolated coronary artery bypass grafting (CABG) in patients with stable coronary artery disease (CAD) and left ventricular (LV) dysfunction at three-year follow-up.

Material and methods. A prospective non-controlled single-center study included 125 consecutive patients with stable CAD and LVEF<50% (62±8 years; 114 [91.2%] males), after isolated CABG. At three-year follow-up MAЕs occurred in 40 (32.0%) patients. The data on pharmacotherapy at follow-up were obtained in 124 patients: 85 (68.6%) patients without MAEs and 39 (31.4%) patients with MAEs.

Results. The enrolled sample of patients was characterized by high discharge prescription rate of renin-angiotensin system (RAS; 86.3%) blockers (angiotensin-converting enzyme inhibitors or angiotensin-II receptors blockers), beta-blockers (BBs; 97.6%) and mineralocorticoid receptors antagonists (MRAs; 79.0%), being comparable in MAEs and non-MAEs groups. The total coverage of basic HF pharmacotherapy (the combination of RAS blockers, BBs and MRAs) at discharge was 66.1%. At follow-up, about one third of patients in both groups withheld previously prescribed triple HF therapy. The MAEs were associated with more frequent withhold of previously prescribed RAS blockers, as opposed to patients without MAEs (20.5% and 7.1%, respectively; р=0.009). The majority of patients in both groups continued BBs therapy at follow-up (95.0% and 92.9%, respectively; p=0.187). Additionally, we observed the decline of MRAs intake frequency at followup (to 43.6% and 49.4%,  respectively; p=0.547). 

Conclusion. During 3-year follow-up after isolated CABG, about one third of patients with  stable CAD and baseline LVEF<50% interrupted triple basic HF therapy (including RAS blockers, BBs and MRAs), mainly due to decrease of RAS blockers and MRAs usage. MAEs in patients with stable CAD and baseline LVEF<50% after CABG were associated with suboptimal use and more frequent interruption of RAS blockers.

About the Authors

O. A. Yepanchintseva
Shupyk National Medical Academy of Postgraduate Education; Heart Institute of the Ministry of Healthcare of Ukraine
Ukraine

PhD, Associate Professor, Head of Department of Heart and Vascular Pathology Diagnostics;  Associate Professor, Chair of Functional Diagnostics

Bratislavskaya ul. 5a, Kyiv, 02660 Ukraine

Dorohozhytska ul. 9, Kyiv, 04112 Ukraine



K. A. Mikhaliev
Research and Practical Center of Preventive and Clinical Medicine
Ukraine
MD, PhD, Senior Researcher, Research Department of Internal Medicine

Verhnyaya ul. 9, Kyiv, 01014 Ukraine


I. V. Shklianka
Heart Institute of the Ministry of Healthcare of Ukraine
Ukraine

MD, PhD, Senior Researcher, Department of Surgical and Minimally Invasive Treatment

Dorohozhytska ul. 9, Kyiv, 04112 Ukraine



O. J. Zharinov
Shupyk National Medical Academy of Postgraduate Education
Ukraine
MD, PhD, Professor, Head of Functional Diagnostics Chair

Bratislavskaya ul. 5a, Kyiv, 02660 Ukraine


B. M. Todurov
Heart Institute of the Ministry of Healthcare of Ukraine
Ukraine
MD, PhD, Corresponding Member of the National Academy of Medical Sciences of Ukraine, CEO

Dorohozhytska ul. 9, Kyiv, 04112 Ukraine


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For citation:


Yepanchintseva O.A., Mikhaliev K.A., Shklianka I.V., Zharinov O.J., Todurov B.M. The Role of Adherence to Basic Pharmacotherapy of Heart Failure for Prevention of Late Adverse Events in Patients with Coronary Artery Disease and Left Ventricular Dysfunction After Surgical Revascularization of Myocardium. Rational Pharmacotherapy in Cardiology. 0;. https://doi.org/10.20996/1819-6446-2020-10-04

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