The influence of concomitant diseases on a long-term prognosis in patients with chronic ischemic heart disease according to the PROGNOZ IBS register
https://doi.org/10.20996/1819-6446-2015-11-6-571-576
Abstract
Aim. To study the incidence of comorbidities and their impact on the prognosis in patients with ischemic heart disease (IHD) included into the PROGNOZ IBS Register.
Material and methods. Data from the PROGNOZ IBS register of patients diagnosed with IHD using coronary angiography during the reference hospitalization (n=541; 432 male and 109 female) was included in the analysis. 504 (93%) patients were included in the survival analysis. Risk factors of cardiovascular diseases, associated with atherosclerosis, or those that were complications of IHD were considered as comorbidities as well as not cardiovascular diseases – chronic obstructive pulmonary disease, bronchial asthma and
chronic kidney disease (CKD).
Results. The average duration of follow-up was 7.3±2.19 years. The average number of comorbidities in patients with IHD was 1.83. Comorbidities worsened the prognosis of life: the presence of diabetes mellitus (DM) increased the relative risk (RR) of primary endpoint occurrence by 1.7 times, the combination of DM with hypertension – by 2.4 times, a history of stroke – by 2.3 times (p<0.05); 2 and 3 heart diseases – respectively, by 2.3 and 3.2 times (p<0.05); a combination of chronic lung diseases and CKD stages 3-5 – by 1.4 times (p=0.06); the presence of 2, 3, 4 and 5 comorbidities – respectively, by 4, 5, 6.4 and 13 times (p<0.001). The risk of death from all causes was determined by the number of concomitant cardiovascular diseases: 2 diseases increased RR by 2.3 times, 3 diseases – by 4.6 times, a combination of any 4 diseases – by 3.5 times, of 5 diseases – by 5 times (p<0.05).
Conclusion. Prognosis of life in IHD patients is worsened by the presence of several comorbidities: risk factors of cardiovascular disease (DM and hypertension), cardiovascular diseases associated with atherosclerosis or those that are complications of IHD, chronic lung diseases and CKD.
About the Authors
S. N. Tolpygina
State Research Centre for Preventive Medicine. Petroverigsky per. 10, Moscow, 101990 Russia
Russian Federation
Russian Federation
S. Yu. Martsevich
State Research Centre for Preventive Medicine. Petroverigsky per. 10, Moscow, 101990 Russia
Russian Federation
Russian Federation
A. D. Deev
State Research Centre for Preventive Medicine. Petroverigsky per. 10, Moscow, 101990 Russia
Russian Federation
Russian Federation
References
1. Demographic Yearbook of Russia 2014. Moscow: Rosstat; 2015. In Russian (Демографический ежегодник России 2014. Москва: Росстат; 2015).
2. Reeves T.J., Oberman A., Jones W.B., Sheffield L.T. Natural history of angina pectoris. Am J Cardiol 1974;33:423−30. 3. Forslund L., Hjemdahl P., Held C., et al. Prognostic implications of results from exercise testing in patients with chronic stable angina pectoris treated with metoprolol or verapamil. A report from The Angina Prognosis Study in Stockholm (APSIS). Eur Heart J 2000;21:901−10.
3. The IONA Study Group. Determinants of coronary events in patients with stable angina: results from the impact of nicorandil in angina study. Am Heart J 2005;150(4):689.
4. Clayton T.C., Lubsen J., Pocock S.J., et al., on behalf of the ACTION investigators. Risk score for predicting death, myocardial infarction, and stroke in patients with stable angina, based on a large randomised trial cohort of patients. BMJ 2005;331:869.
5. Timmis AD, Feder G, Hemingway H. Prognosis of stable angina pectoris: why we need larger population studies with higher endpoint resolution. Heart 2007;93:786-91;
6. Lupanov VP, Chotchaev HH, Evstifeeva SE, et al. The clinical course of the disease and the prognosis in patients with coronary heart disease with stable angina caused by stenotic coronary atherosclerosis (the data 20-year follow-up). Ter Arkhiv 2002; 74 (9): 13-20. In Russian (Лупанов В.П., Чотчаев Х.Х., Евстифеева С.Е. и др. Клиническое течение заболевания и прогноз у больных ишемической болезнью сердца со стабильной стенокардией, обусловленной стенозирующим коронарным атеросклерозом (данные 20-летнего наблюдения). Терапевтический Архив 2002;74(9):13−20).
7. Boytsov SA, Martsevich SY, Kutishenko NP, et al. The registers in cardiology. Basic rules of conduct and the real possibilities. Kardiovaskulyarnaya Terapiya i Profilaktika 2013; 12 (1): 4-9. In Russian (Бойцов С.А., Марцевич С.Ю., Кутишенко Н.П., и др. Регистры в кардиологии. Основные правила проведения и реальные возможности. Бойцов Кардиоваскулярная Терапия и Профилактика 2013; 12 (1): 4-9).
8. Bluzhas Yu, Radauskas R, Bernotene, et al. Prevalence of major cardiovascular diseases Kaunas residents for the 1983-2000 biennium. Kardiologiia 2005; 45 (7): 54-5. In Russian (Блужас Ю., Радишаускас Р., Бернотене Г. И др. Распространенность основных сердечно-сосудистых заболеваний жителей Каунаса за 1983-2000 гг. Кардиология 2005; 45(7):54-5).
9. Singh M., Rihal C.S., Gersh B.J.; et al. Twenty-five-year trends in in-hospital and long-term outcome after percutaneous coronary intervention: a single-institution experience. Circulation 2007; 115: 2835-241.
10. Lemos P.A., Serruys P.W., van Domburg R.T. et al. Unrestricted utilization of sirolimus-eluting stents RESEARCH) registry, compared with conventional bare stent implantation in the “real world”: the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. Circulation 2004; 109: 190-5.
11. Williams D.O., Abbott J.D., Kip K.E. Outcomes of 6906 patients undergoing percutaneous coronary intervention in the era of drug-eluting stents: report of the DEScover Registry. Circulation 2006; 114: 2154-62.
12. Panchenko EP, Belenkov YN. Characteristics and outcomes of atherothrombotic events in ambulatory patients in the Russian Federation (based on the REACH International Register). Kardiologiia 2008; 2: 17-24. In 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).
13. Lukyanov MM, Boytsov SA, Jakushin SS, et al. Diagnosis, treatment, concomitant cardiovascular disease and comorbidities in patients with a diagnosis of "atrial fibrillation" in a real outpatient practice (according to Register cardiovascular disease REKVAZA). Ration Pharmacother Cardiol 2014; 10 (4): 366-77. In Russian (Лукьянов М.М, Бойцов С.А., Якушин C.С., и др. Диагностика, лечение, сочетанная сердечно-сосудистая патология и сопутствующие заболевания у больных с диагнозом «фибрилляция предсердий» в условиях реальной амбулаторно-поликлинической практики (по данным РЕгистра КардиоВАскулярных ЗАболеваний РЕКВАЗА) Рациональная Фармакотерапия в Кардиологии 2014;10(4):366-77).
14. Lukyanov MM, Boytsov SA, Jakushin SS, et al. Register outpatient cardiovascular disease (REKVAZA): prospective study data, risk assessment, and outcomes in patients with atrial fibrillation. Ration Pharmacother Cardiol 2014; 10 (5): 470-80. In Russian (Лукьянов М.М, Бойцов С.А., Якушин C.С., и др. Амбулаторно-поликлинический РЕгистр КардиоВАскулярных ЗАболеваний (РЕКВАЗА): данные проспективного наблюдения, оценка риска и исходы у больных с фибрилляцией предсердий. Рациональная Фармакотерапия в Кардиологии 2014;10(5):470-80).
15. Fortin M., Lapointe L., Hudon C., et al. Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes 2004;2:51.
16. Munoz E., Rosner F., Friedman R., et al. Financial risk, hospital cost, complications and comorbidities in medical non-complications and comorbidity-stratified diagnosis-related groups. Am J Med 1988;84(5):933-9.
17. Zhang M., Holman C. D., Price S. D. et al. Comorbidity and repeat admission to hospital for adverse drug reactions in older adults: retrospective cohort study. BMJ 2009;338:a2752.
18. Wang P.S., Avorn J., Brookhart M.A. Effects of noncardiovascular comorbidities on antihypertensive use in elderly hypertensives. Hypertension 2005; 46 (2):273-9.
19. Hofman EA, Martsevich SY, Tolpygina SN et al. The first results of the PROGNOZ IBS study. Klinitsist 2012;1:58-64. In Russian (Гофман Е.А., Марцевич С.Ю., Толпыгина С.Н. и др. Первые результаты исследования ПРОГНОЗ ИБС. Клиницист 2012;1:58-64).
20. Tolpygina SN, Martsevich SY, Hofman EA et al. The experience of creating a register for evaluating outcomes of chronic leaking of coronary heart disease: PROGNOZ IBS study" Kardiovaskulyarnaya Terapiya i Profilaktika 2013;1:32-9. In Russian (Толпыгина С.Н, Марцевич С.Ю., Гофман Е.А. и др. Опыт создания регистра для оценки исходов хронически протекающей ишемической болезни сердца: исследование «ПРОГНОЗ ИБС». Кардиоваскулярная Терапия и профилактика 2013;1:32-9).
21. Martsevich SY, Malyshev AM, Tolpygina SN et al. The role of individual performance and individual indices integrated test with dosed physical load on the treadmill in the assessment of the risk of complications in patients with chronic ischemic heart disease. Kardiovaskulyarnaya Terapiya i Profilaktika 2012; 11 (2): 44-52. In Russian (Марцевич С.Ю., Малышева А.М., Толпыгина С.Н. и др. Роль отдельных показателей и отдельных интегральных индексов пробы с дозированной физической нагрузкой на тредмиле в оценке риска осложнений у пациентов с хронической ИБС. Кардиоваскулярная Терапия и профилактика 2012;11(2):44-52).
22. Martsevich SY, Tolpygina SN, Malyshev AM, et al. The value of individual indicators and indices integrated test with dosed physical load on the treadmill to identify the severity of stenotic coronary arteries. Kardiovaskulyarnaya Terapiya i Profilaktika 2013; 12 (5): 22-8. In Russian (Марцевич С.Ю., Толпыгина С.Н., Малышева А.М., и др. Значение отдельных показателей и интегральных индексов пробы с дозированной физической нагрузкой на тредмиле для выявления тяжести стенотического поражения коронарных артерий. Кардиоваскулярная Терапия и Профилактика 2013;12(5):22-8).
23. Tolpygina SN, Martsevich SY, Hofman EA, Deev AD. The prognostic significance of these instrumental studies in chronic coronary heart disease occurring in patients register "PROGNOZ IBS." Kardiovaskulyarnaya Terapiya i Profilaktika 2014; 13 (4): 29-35. In Russian (Толпыгина С.Н., Марцевич С.Ю., Гофман Е.А., Деев А.Д. Прогностическое значение данных инструментальных исследований при хронически протекающей ИБС у пациентов регистра «ПРОГНОЗ ИБС». Кардиоваскулярная Терапия и профилактика 2014;13(4):29-35).
24. Tolpygina SN, Polyanskaya YN, Martsevich SY. Treatment of patients with chronic coronary heart disease in clinical practice, according to the PROGNOZ IBS register (Part 1). Ration Pharmacother Cardiol 2013; 9 (2): 138-42. In Russian (Толпыгина С.Н Полянская Ю.Н. Марцевич С.Ю. Лечение пациентов с хронической ИБС в реальной клинической практике по данным регистра ПРОГНОЗ ИБС (часть 1). Рациональная Фармакотерапия в Кардиологии 2013; 9(2):138—42).
25. Tolpygina SN, Polyanskaya YN, Martsevich SY. Treatment of patients with chronic coronary heart disease in clinical practice, according to the PROGNOZ IBS register (Part 2). Ration Pharmacother Cardiol 2013; 9 (5): 494-9. In Russian (Толпыгина С.Н Полянская Ю.Н. Марцевич С.Ю. Лечение пациентов с хронической ИБС в реальной клинической практике по данным регистра ПРОГНОЗ ИБС (часть 2). Рациональная Фармакотерапия в Кардиологии 2013; 9(5):494-9).
26. Tolpygina SN, Polyanskaya YN, Martsevich SY. Lipid-lowering therapy in patients with chronic ischemic heart disease in 2004-2007, according to the register PROGNOZ IBS. Ration Pharmacother Cardiol 2015; 11 (2): 153-8. In Russian (Толпыгина С.Н., Полянская Ю.Н., Марцевич С.Ю. Гиполипидемическая терапия у пациентов с хронической ИБС в 2004-2007 гг по данным регистра ПРОГНОЗ ИБС. Рациональная Фармакотерапия в Кардиологии 2015;11(2):153-8).
27. Lukina YV, Polyanskaya YN, Tolpygina SN, et al. Study of adherence to treatment with statins in patients with chronic ischemic heart disease and compliance with lipid-lowering therapy clinical guidelines (according to the register PROGNOZ IBS. Profilakticheskaya Meditsina 2014; 17 (4): 39-43. In Russian (Лукина Ю.В., Полянская Ю.Н., Толпыгина С.Н., и др. Изучение приверженности лечению статинами у пациентов с хронической ишемической болезнью сердца и соответствия гиполипидемической терапии клиническим рекомендациям (по данным регистра ПРОГНОЗ ИБС. Профилактическая Медицина 2014; 17(4): 39-43).
28. Boytsov SA, Lukyanov MM, Jakushin SS, et al. Register cardiovascular disease (REKVAZA): diagnosis, concomitant cardiovascular disease, comorbidity and treatment in conditions of real outpatient practice. Kardiovaskulyarnaya Terapiya i Profilaktika 2014; 13 (6): 44-50. In Russian (Бойцов С.А., Лукьянов М.М., Якушин C.С., и др. Регистр кардиоваскулярных заболеваний (РЕКВАЗА): диагностика, сочетанная сердечно-сосудистая патология, сопутствующие заболевания и лечение в условиях реальной амбулаторно-поликлинической практики. Кардиоваскулярная Терапия и Профилактика 2014;13(6):44-50).
29. Fortin M., Bravo G., Hudon C., et al. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 2005;3:223-8.
30. Boytsov SA, Lukyanov MM, Jakushin SS, et al. Outpatient Register REKVAZA: prospective study data, risk assessment, and outcomes in patients with cardio-vascular diseases. Kardiovaskulyarnaya Terapiya i Profilaktika 2015;14(1):53-62. In Russian (Бойцов С.А., Лукьянов М.М., Якушин C.С., и др. Амбулаторно-поликлинический регистр РЕКВАЗА: данные проспективного наблюдения, оценка риска и исходы у больных кардио-васкулярными заболеваниями. Кардиоваскулярная Терапия и Профилактика 2015;14(1):53-62).
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For citations:
Tolpygina S.N., Martsevich S.Yu., Deev A.D. The influence of concomitant diseases on a long-term prognosis in patients with chronic ischemic heart disease according to the PROGNOZ IBS register. Rational Pharmacotherapy in Cardiology. 2015;11(6):571-576. (In Russ.) https://doi.org/10.20996/1819-6446-2015-11-6-571-576
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