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Comparative Characteristics of Patients with Cerebral Stroke and Myocardial Infarction in Outpatient Practice: Structure of Comorbidity, Risk Factors, Drug Treatment and Outcomes

https://doi.org/10.20996/1819-6446-2020-10-19

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Abstract

Aim. To conduct a comparative analysis of clinical and anamnestic characteristics, risk factors, pharmacotherapy and outcomes in patients with previous stroke and myocardial infarction (MI) in outpatient practice based on data from prospective outpatient registries.

Material and methods. On the basis of three outpatient clinics in Ryazan, based on the results of treatment in 2012-2013, an outpatient registry of patients who had stroke of any remoteness (REGION-AR) and an outpatient registry of patients who had previous myocardial infarction (REGATA) were created, which included, respectively, 511 patients (212 men, 41.5%) and 481 patients (247 men, 51.4%). Clinical and anamnestic characteristics, risk factors, prescribed pharmacotherapy, and its compliance with clinical guidelines were evaluated.

Results. Most of the patients in the REGION-AR and REGATA registries were diagnosed with arterial hypertension (AH; 97.1% and 98.5%), coronary heart disease (СHD; 75.1% and 100%), chronic heart failure (CHF; 74.0% and 94.8%), and the proportion of atrial fibrillation (AF) cases were 20.9% and 23.3%, respectively. The share of smokers was significantly higher (23.4% vs 8.9%; p<0.0001) in the REGATA registry, and the share of people with high blood pressure at the inclusion visit (82.6% vs 67.6 %; p<0.0001) and hypercholesterolemia (63.8% vs 45.8%; p<0.0001) was higher in the REGION-AR registry. In both registries, there was a generally insufficient frequency of proper medication prescriptions, while patients in the REGION registry were statistically significantly less likely to receive mandatory prescriptions in general (44.4% vs 58.2%, p<0.0001), including antihypertensive therapy for hypertension, as well as angiotensin-converting-enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) in CHF, beta-blockers in CHF and MI history, statins in CHD, antiplatelet agents in CHD without AF. Over 3 years of follow-up, the degree of compliance of drug prescriptions with clinical recommendations increased both in the REGION-AR registry (from 44.4% to 58.2%) and in the REGATA registry (from 58.2% to 62.9%). For 36 months of prospective observation in the REGION-AR registry, as compared to the REGATA registry, there was a higher mortality rate (22.1% vs 17.0%; p=0.04), moreover the mortality rate among men was higher (22.2% vs 14.2%; p=0.03), and among women it did not differ significantly (22.1% and 20.0%; p=0.56).

Conclusion. Outpatient registries of patients who survived after acute cerebrovascular accident and myocardial infarction were comparable in terms of the average age of patients, however, women prevailed in the REGION-AR study, and men - in the REGATA registry. In the registry of patients who had myocardial infarction, СHD, CHF, respiratory and digestive system diseases, chronic kidney disease, obesity were more often diagnosed, less often – heart defects and oncological diseases. This category of patients was more often prescribed ACE inhibitors/ARBs, beta-blockers, statins, antiplatelet agents. The proportion of compliance of prescriptions with clinical guidelines was higher in the registry of patients who underwent MI both at the stage of inclusion and during subsequent prospective observation. In both registries, an improvement in the quality of drug therapy was noted after 3 years of follow-up. Mortality from all causes over 3 years of follow-up was significantly higher in the registry of post-stroke patients compared to the registry of those with MI, and this was due to the higher mortality in men (1.6 times), but among women in the compared studies the death rate did not differ significantly.

About the Authors

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

Alexander N. Vorobyev – MD, PhD, Associate Professor, Chair of Outpatient Therapy and Preventive Medicine

Vysokovoltnaya ul. 9, Ryazan, 390026



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

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

Vysokovoltnaya ul. 9, Ryazan, 390026



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

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

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 Therapy and Preventive Medicine
Russian Federation

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

Petroverigsky per. 10, Moscow, 101990



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

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

Petroverigsky per. 10, Moscow, 101990



O. M. Drapkina
National Medical Research Center for Therapy and 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. Virani S.S., Alonso A., Benjamin E.J., et al. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation. 2020;3;141(9):e139-e596. DOI:10.1161/CIR.0000000000000757.

2. Danilov A.V., Kobzar I.I., Nagibin O.A., et al. Morbidity and mortality from cardiovascular diseases in Ryazan district: 2014-2018 Science of the young (Eruditio Juvenium). 2019;7(3):439-49 (In Russ.) DOI:10.23888/HMJ201973439-449.

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

4. 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.

5. January C.T., Wann L.S., Calkins H., et al. 2019 AHA/ ACC/HRS Focused Update of the 2014 AHA/ACC/ HRS Guideline for the Management of Patients With Atrial Fibrillation. Journal of the American College of Cardiology. 2019;74(1):104-32. DOI:10.1016/j.jacc.2019.01.011.

6. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-77. DOI:10.1093/eurheartj/ehz425.

7. Cardiovascular prevention 2017. National guidelines. Russ J Cardiol. 2018;23(6):7-122 (In Russ.) DOI:10.15829/1560-4071-2018-6-7-122.

8. Boytsov S.A., Martsevich S.Yu., Kutishenko N.P. et al. Registers in cardiology. Basic rules and real opportunities. Cardiovascular Therapy and Prevention. 2013;12(1):4-9 (In Russ.) DOI:10.15829/1728-8800-2013-1-4-9.

9. 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:10.20996/1819-6446-2018-14-6-879-886.

10. 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.

11. Pereverzeva K.G., Yakushin S.S., Gracheva A.I., et al. Post-myocardial infarction patients: a comparison of management by a physician and a cardiologist according to the REGATA register. Cardiovascular Therapy and Prevention. 2020;19(3):2525 (In Russ.) DOI:10.15829/1728-8800-2020-2525.

12. Pereverzeva K.G., Vorobyev A.N., Nikulina N.N., et al. Features of examination of patients with coronary heart disease in outpatient practice according to observation in a registry study. Pavlov Russian Medical Biological Herald. 2014;22(1):90-6 (In Russ.) DOI:10.17816/PAVLOVJ221.

13. Okshina E.Y., Loukianov M.M., Martsevich S.Y., et al. Patients with History of Myocardial Infarction and Acute Cerebrovascular Accident in Clinical Practice: Demographic, Clinical Characteristics, Drug Treatment and Outcomes (Data of Outpatient and Hospital Registry REGION). Rational Pharmacotherapy in Cardiology. 2019;15(5):656-62 (In Russ.) [Окшина Е.Ю., Лукьянов М.М., Марцевич С.Ю., и др. Больные с сочетанием перенесенных инфаркта миокарда и острого нарушения мозгового кровообращения в клинической практике: демографические и клинико-анамнестические характеристики, медикаментозное лечение и исходы (данные амбулаторных и госпитального регистров РЕГИОН). Рациональная Фармакотерапия в Кардиологии. 2019;15(5):656-62]. DOI:10.20996/1819-6446-2019-15-5-656-662

14. Lekander I., Willers C., Ekstrand E., et al. Hospital comparison of stroke care in Sweden: a registerbased study. BMJ Open. 2017;7:e015244. DOI:10.1136/bmjopen-2016-015244.4.

15. Takashima N., Arima H., Kita Y. Two-Year Survival After First-Ever Stroke in a General Population of 1.4 Million Japanese - Shiga Stroke Registry. Circ J. 2018;82(10):2549-56. DOI:10.1253/circj.CJ18-0346.

16. Martsevich S.Y., Kutishenko N.P., Suvorov A.Y., et al. Characteristics of patients with cerebral stroke or transient ischemic attack, included in the register of LIS-2 (Lyubertsy study mortality in patients after stroke). Rational Pharmacotherapy in Cardiology. 2015;11(1):18-24 (In Russ.) DOI:10.20996/1819-6446-2015-11-1-18-24.

17. Kotova E.Y., Mashin V.V. Epidemiology and major risk factors for the development of stroke in Ulyanovsk (according to the register of stroke). Ulyanovsk Medico-Biological Journal. 2011;2:100- 7 (In Russ.)

18. Venketasubramanian N., Yoon B.W., Pandianet J., et al. Stroke in South, East, and South-East Asia: Review. Journal of Stroke. 2017;19(3):286-94. DOI:10.5853/jos.2017.00234.

19. Jang M.U., Kang J., Kim B.J., et al. In-Hospital and Post-Discharge Recovery after Acute Ischemic Stroke: a Nationwide Multicenter Stroke Registry-base Study. J Korean Med Sci. 2019;34(36):e240. DOI:10.3346/jkms.2019.34.e240.

20. Martsevich S.Yu., Semenova Y.V., Kutishenko N.P., et al. LIS-3 Register of the Acute Coronary Syndrome: what has Changed in a "Portrait" of a Patient and Short-Term Outcomes of the Disease Compared to LIS-1. Rational Pharmacotherapy in Cardiology. 2017;13(1):63-8 (In Russ.) DOI:10.20996/1819-6446-2017-13-1-63-68.

21. Mehta R.H., Chen A.Y., Alexander K.P., et al. Doing the right things and doing them the right way: association between hospital guideline adherence, dosing safety, and outcomes among patients with acute coronary syndrome. Circulation. 2015;131(11):980-987. DOI:10.1161/CIRCULATIONAHA.114.013451.

22. Malay L.N, Solokhina L.V., Bukhonkina Y.M., et al. Characteristic features, treatment and hospital outcomes in patients with acute myocardial infarction: Khabarovsk Register data. Part I. Rational Pharmacotherapy in Cardiology. 2016;12(1):56-62. (In Russ.) DOI:10.20996/1819-6446-2016-12-1-56-62.

23. Echouffo-Tcheugui J.B., Xu H., Matsouaka R.A., et al. Diabetes and long-term outcomes of ischaemic stroke: findings from Get With The Guidelines-Stroke. Eur Heart J. 2018;0:1-11. DOI:10.1093/eurheartj/ehy036.

24. Ntaios G., Georgiopoulos G., Koroboki E., et al. Validation of the PREMISE score in the Athens Stroke Registry. Journal of Stroke and Cerebrovascular Diseases. 2019;28(7):1806-9. DOI:10.1016/j.jstrokecerebrovasdis.2019.04.023.

25. 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.)

26. Vasileva L.V., Shevchenko I.I., Erlih A.D., et al. The Dynamics of Treatment and Hospitalization Outcomes in Patients with Acute Coronary Syndrome in «Non-Invasive» Hospitals («RECORD» Series of Registers Data). Difficult Patient. 2016;1(14):5-10 (In Russ.)

27. Zeymer U., James S., Berkenboom G., et al. Differences in the use of guideline-recommended therapies among 14 European countries in patients with acute coronary syndromes undergoing PCI. Eur J Prev Cardiol. 2013;20(2):218-28. DOI:10.1177/2047487312437060.

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


For citation:


Vorobyev A.N., Pereverzeva K.G., Loukianov M.M., Yakushin S.S., Martsevich S.Yu., Okshina E.Yu., Drapkina O.M. Comparative Characteristics of Patients with Cerebral Stroke and Myocardial Infarction in Outpatient Practice: Structure of Comorbidity, Risk Factors, Drug Treatment and Outcomes. Rational Pharmacotherapy in Cardiology. 2020;16(5):713-720. (In Russ.) https://doi.org/10.20996/1819-6446-2020-10-19

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