THE WAY OF ASSESSING THE ADHERENCE TO MODERN DRUG THERAPY CLINICAL GUIDELINES AIMED AT REDUCING THE RISK OF RECURRENT STROKE (ACCORDING TO THE LIS-2 REGISTER)
https://doi.org/10.20996/1819-6446-2015-11-1-45-52
Abstract
Aim. To develop a method for the assessment of quality of medical prevention of recurrent stroke and its’ testing using the results of the LIS-2 register (Lyubertsy study of mortality in patients after stroke).
Material and methods. The scale evaluation of the quality of therapy for the prevention of recurrent stroke developed in accordance with the modern clinical practice guidelines, as well as the recurrent stroke prevention index (RSPI) for this assessment were elaborated. The analysis of the therapy was performed in patients after stroke in LIS-2 registers (n=219). The assessment of the quality of treatment was performed using RSPI, the influence of the index results on the in-hospital mortality was studied.
Results. Two groups of patients [with RSPI=0 (n=137) and RSPI>0 (n=82)] were formed on the basis of the results evaluation via RSPI. Significant differences between groups were not found. At the same time higher in-hospital mortality (p=0.014; χ2 Pearson) was detected in patients with RSPI=0; relative risk of in-hospital death (after adjustment for sex and age) was 2.04 [1.07-3.91] (p=0.031). Analysis of the length of survival and duration of hospital stay was performed in both groups using the Kaplan-Meier method. In-hospital mortality was significantly higher in patients with RSPI=0, which was confirmed by the log-rank test (p=0.032).
Conclusion. The results of the quality of medical care assessment in accordance with the developed method are significantly related to the outcomes during the stay in a hospital. The developed method, based on current clinical recommendations, can serve as an example of the implementation of evidence-based medicine in actual practice.
About the Authors
A. Yu. Suvorov
State Research Centre for Preventive Medicine
Russian Federation
Petroverigsky per. 10, Moscow, 101990 Russia
Russian Federation
Petroverigsky per. 10, Moscow, 101990 Russia
S. Yu. Martsevich
State Research Centre for Preventive Medicine
Russian Federation
Petroverigsky per. 10, Moscow, 101990 Russia
Russian Federation
Petroverigsky per. 10, Moscow, 101990 Russia
N. P. Kutishenko
State Research Centre for Preventive Medicine
Russian Federation
Petroverigsky per. 10, Moscow, 101990 Russia
Russian Federation
Petroverigsky per. 10, Moscow, 101990 Russia
A. D. Deev
State Research Centre for Preventive Medicine
Russian Federation
Petroverigsky per. 10, Moscow, 101990 Russia
Russian Federation
Petroverigsky per. 10, Moscow, 101990 Russia
M. L. Ginzburg
State Research Centre for Preventive Medicine, Lyubertsy Regional Hospital №2
Russian Federation
Russian Federation
Petroverigsky per. 10, Moscow, 101990 Russia
Oktyabr’skiy prospect 338, Moscow Region, Lyubertsy, 140006 Russia
A. V. Akimova
Russian Federation
the "LIS-2" study Working Group
E. V. Daniels
Russian Federation
the "LIS-2" study Working Group
N. A. Dmitrieva
Russian Federation
the "LIS-2" study Working Group
L. Yu. Drozdova
Russian Federation
the "LIS-2" study Working Group
N. Yu. Zhuravskaya
Russian Federation
the "LIS-2" study Working Group
O. V. Lerman
Russian Federation
the "LIS-2" study Working Group
Yu. V. Lukina
Russian Federation
the "LIS-2" study Working Group
M. M. Loukianov
Russian Federation
the "LIS-2" study Working Group
V. P. Smirnov
Russian Federation
the "LIS-2" study Working Group
A. V. Fokina
Russian Federation
the "LIS-2" study Working Group
References
1. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation 2013;127(1):e6-e245.
2. Hankey GJ. Long-term outcome after ischaemic stroke/transient ischaemic attack. Cerebrovasc Dis 2003;16 Suppl 1:14-9.
3. Frizzell JP. Acute stroke: pathophysiology, diagnosis, and treatment. AACN clinical issues 2005;16(4):421-40; quiz 597-8.
4. Steiner T, Juvela S, Unterberg A, et al. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 2013;35(2):93-112.
5. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008;25(5):457-507.
6. Connolly ES, Jr., Rabinstein AA, Carhuapoma JR, et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke 2012;43(6):1711-37.
7. Morgenstern LB, Hemphill JC, 3rd, Anderson C, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2010;41(9):2108-29.
8. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2014;45(7):2160-236.
9. Post-stroke antihypertensive treatment study. A preliminary result. Chinese medical journal. 1995;108(9):710-7.
10. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001;358(9287):1033-41.
11. Schrader J, Luders S, Kulschewski A, et al. Morbidity and Mortality After Stroke, Eprosartan Compared with Nitrendipine for Secondary Prevention: principal results of a prospective randomized controlled study (MOSES). Stroke 2005;36(6):1218-26.
12. Amarenco P, Bogousslavsky J, Callahan A, 3rd, et al. High-dose atorvastatin after stroke or transient ischemic attack. NEJM 2006;355(6):549-59.
13. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Archives of internal medicine 1994;154(13):1449-57.
14. Diener HC, Cunha L, Forbes C, et al. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. Journal of the neurological sciences 1996;143(1-2):1-13.
15. Martsevich S.Yu., Voronina V.P., Drozdova L.Yu. Doctor’s health and education: two components of success. Ration Pharmacother Cardiol 2010;6(1):73-6. Russian (Марцевич С.Ю., Воронина В.П., Дроздова Л.Ю. Здоровье и образование врача: две составляющие успеха. Рациональная Фармакотерапия в Кардиологии 2010;6(1):73-6).
16. Spirin N.N., Korneeva N.N. Data from hospital stroke in Kostroma. Fundamental'nye Issledovaniya 2012; 4: 123-8. Russian (Спирин Н.Н., Корнеева Н.Н. Данные госпитального инсульта в Костроме. Фундаментальные Исследования 2012;4:123-8).
17. Malakshinova ZH, Manzhueva TK, Tsyrenov B.Ts. Morbidity and mortality from stroke in Ulan-Ude, according to the register in 2005-2007. Byulleten' VSNTs SO RAMN 2008; 3 (61): 99-100. Russian (Малакшинова З.Х., Манжуева Т.К., Цыренов Б.Ц. Заболеваемость и смертность от мозгового инсульта в г. Улан-Удэ по данным регистра за 2005-2007 гг. Бюллетень ВСНЦ СО РАМН 2008;3(61):99-100).
18. Lebedev IA, Anischenko LI, Akinina SA, Ivanova NE, Sokolova AA Clinical and epidemiological features of stroke in the Khanty-Mansi Autonomous District (population register trial). Vestnik Rossiyskoy Voennomeditsinskoy akademii 2011; 3 (35): 103-7.Russian (Лебедев И.А., Анищенко Л.И., Акинина С.А., Иванова Н.Е., Соколова А.А. Клинико-эпидемиологические особенности мозгового инсульта в Ханты-Мансийском автономном округе (по данным популяционного регистра). Вестник Российской Военно-медицинской академии 2011;3(35):103-7).
19. Kotova E.Ju., Mashin V.V. Epidemiology and major risk factors for stroke in Ulyanovsk (according to the register of stroke). Ul'yanovskiy mediko-biologicheskiy zhurnal 2011; 2: 100-7. Russian (Котова Е.Ю., Машин В.В. Эпидемиология и основные факторы риска развития инсульта в г. Ульяновске (по данным регистра инсульта). Ульяновский медико-биологический журнал 2011;2:100-7).
20. Starodubceva O.S., Begicheva S.V. Analysis of the incidence of stroke with the use of information technology. Fundamental'nye issledovaniya 2012; 8: 424-7. Russian (Стародубцева О.С., Бегичева С.В. Анализ заболеваемости инсультом с использованием информационных технологий. Фундаментальные исследования 2012;8:424-7).
21. Bidenk, MA, Shprakh BB., Martynenko EA Structure, outcomes and risk factors of stroke according to the hospital register in Irkutsk. Sibirskiy meditsinskiy zhurnal 2008; 4. Russian (Биденко, М.А., Шпрах, ВВ., Мартыненко Е.А. Структура, исходы и факторы риска мозговых инсультов по данным госпитального регистра в г. Иркутске. Сибирский медицинский журнал 2008;4).
22. Suvorov A.Ju. Marcevich S.Ju., Kutishenko N.P. Assessment of quality of care in the registers of acute stroke. foreign experience and prospects of Russia. Kardiovaskulyarnaya terapiya i profilaktika 2014; 13 (4): 81-6. Russian (Суворов А.Ю. Марцевич С.Ю., Кутишенко Н.П. Оценка качества терапии в регистрах острого нарушения мозгового кровообращения. зарубежный опыт, перспективы России. Кардиоваскулярная терапия и профилактика 2014;13(4):81-6).
23. Suvorov A.Ju., Marcevich S.Ju. Modern principles of assessing the quality of the treatment of cardiovascular diseases. Ration Pharmacother Cardiol 2014; 10 (4): 397-401. Russian (Суворов А.Ю., Марцевич С.Ю. Современные принципы оценки качества проводимого лечения сердечно-сосудистых заболеваний. Рациональная Фармакотерапия в Кардиологии. 2014;10(4):397-401).
24. Marcevich SJu, Kutishenko NP, Suvorov AJu, Ginzburg ML, Deev AD, Bojcov SA, 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). Ration Pharmacother Cardiol 2015; 11 (1):18-24 . Russian (Марцевич СЮ, Кутишенко НП, Суворов АЮ, Гинзбург МЛ, Деев АД, Бойцов СА, et al. Характеристика пациентов с мозговым инсультом или транзиторной ишемической атакой, включенных в регистр ЛИС-2 (Люберецкое исследование смертности больных, перенесших мозговой инсульт). Рациональная Фармакотерапия в Кардиологии 2015;11(1):18-24).
25. Bojcov S.A., Marcevich S.Ju., Ginzburg M.L., et al. Lubertsy study mortality in patients after stroke or transient ischemic attack (PIM-2). Design and evaluation of drug therapy. Ration Pharmacother Cardiol 2013; 9 (2): 114-22. Russian (Бойцов С.А., Марцевич С.Ю., Гинзбург М.Л., и др. Люберецкое исследование смертности больных, перенесших мозговой инсульт или транзиторную ишемическую атаку (ЛИС-2). Дизайн и оценка лекарственной терапии. Рациональная фармакотерапия в кардиологии 2013;9(2):114-22).
26. Gusev E.I, Martynov M.Ju., Kolesnikova T.I., et al. Fezam in treatment of disorders of cerebral circulation. Zhurnal nevrologii i psikhiatrii im.S.S.Korsakova 2008; 108 (2): 24-26. Russian (Гусев Е.И, Мартынов М.Ю., Колесникова Т.И., и др. Фезам в комплексном лечении нарушений мозгового кровообращения. Журнал неврологии и психиатрии им.С.С.Корсакова 2008; 108 (2): 24-26).
27. Chuprina S. E. Application of omaron in the rehabilitation of stroke patients. Zhurnal nevrologii i psikhiatrii im.S.S.Korsakova 2010; 110 (6): 54-7. Russian (Чуприна С. Е. Применение омарона при реабилитации перенесших инсульт пациентов. Журнал неврологии и психиатрии им. С. С. Корсакова 2010; 110 (6): 54-7).
28. Parfenov V.A., Belavina G.R., Vakhnina N.V., et al. Application omarona in patients with post-stroke cognitive impairment. Zhurnal nevrologii i psikhiatrii im.S.S.Korsakova 2009; 6: 47-51. Russian (Парфенов В.А., Белавина Г.Р., Вакхнина Н.В., и др. Применение омарона у пациентов с постинсультными когнитивными расстройствами. Журнал неврологии и психиатрии им. С. С. Корсакова 2009; 6: 47-51).
29. Odinak M.M., Skvorcova V.I., Voznjuk I.A., et al. Evaluating the effectiveness of cytoflavin in patients with acute ischemic stroke. Zhurnal nevrologii i psikhiatrii im.S.S.Korsakova 2010; 110 (12): 29-36. Russian (Одинак М.М., Скворцова В.И., Вознюк И.А., и др. Оценка эффективности цитофлавина у больных в остром периоде ишемического инсульта. Журнал неврологии и психиатрии им. С. С. Корсакова 2010; 110 (12): 29-36).
30. Rumjanceva S.A., Fedin A.I., Bolevich S.B. et al. Effect of early cor energy and free radical homeostasis on climate technical and morphological picture of cerebral infarction. Zhurnal nevrologii i psikhiatrii im.S.S.Korsakova 2010; 110: 8: 16-21. Russian (Румянцева С.А., Федин А.И., Болевич С.Б. и др. Влияние ранней коррекции энергетического и свободнорадикального гомеостаза на клиническую и морфологическую картину инфаркта мозга. Журнал неврологии и психиатрии им. С. С. Корсакова 2010; 110: 8: 16-21).
31. Heiss WD, Brainin M, Bornstein NM, et al. Cerebrolysin in patients with acute ischemic stroke in Asia: results of a double-blind, placebo-controlled randomized trial. Stroke 2012;43(3):630-6.
32. Ladurner G, Kalvach P, Moessler H. Neuroprotective treatment with cerebrolysin in patients with acute stroke: a randomised controlled trial. J Neural Transm 2005;112(3):415-28.
33. De Deyn PP, Reuck JD, Deberdt W, et al. Treatment of acute ischemic stroke with piracetam. Members of the Piracetam in Acute Stroke Study (PASS) Group. Stroke 1997;28(12):2347-52.
34. Grotemeyer KH, Evers S, Fischer M, Husstedt IW. Piracetam versus acetylsalicylic acid in secondary stroke prophylaxis. A double-blind, randomized, parallel group, 2 year follow-up study. Journal of the neurological sciences 2000;181(1-2):65-72.
35. van Tuijl JH, van Raak EP, de Krom MC, et al. Early treatment after stroke for the prevention of late epileptic seizures: a report on the problems performing a randomised placebo-controlled double-blind trial aimed at anti-epileptogenesis. Seizure 2011;20(4):285-91.
36. Feigin VL, Doronin BM, Popova TF, et al. Vinpocetine treatment in acute ischaemic stroke: a pilot singleblind randomized clinical trial. European journal of neurology 2001;8(1):81-5.
37. Hsu CY, Norris JW, Hogan EL, et al. Pentoxifylline in acute nonhemorrhagic stroke. A randomized, placebocontrolled double-blind trial. Stroke 1988;19(6):716-22.
Review
For citations:
Suvorov A.Yu., Martsevich S.Yu., Kutishenko N.P., Deev A.D., Ginzburg M.L., Akimova A.V., Daniels E.V., Dmitrieva N.A., Drozdova L.Yu., Zhuravskaya N.Yu., Lerman O.V., Lukina Yu.V., Loukianov M.M., Smirnov V.P., Fokina A.V. THE WAY OF ASSESSING THE ADHERENCE TO MODERN DRUG THERAPY CLINICAL GUIDELINES AIMED AT REDUCING THE RISK OF RECURRENT STROKE (ACCORDING TO THE LIS-2 REGISTER). Rational Pharmacotherapy in Cardiology. 2015;11(1):45-52. (In Russ.) https://doi.org/10.20996/1819-6446-2015-11-1-45-52
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