PHARMACOTHERAPY ANALYSIS OF ACUTE ST-ELEVATION MYOCARDIAL INFARCTION IN HOSPITALS OF VARIOUS TYPES
https://doi.org/10.20996/1819-6446-2011-7-6-733-738
Abstract
Aim. To evaluate pharmacotherapy of ST-elevation myocardial infarction (STEMI) in cardiology departments of Saratov hospitals of various types. Material and methods. The retrospective pharmacoepidemiological study was carried out with involved of 424 hospital charts of STEMI patients, discharged during the year from the cardiology department of Saratov municipal hospital (MH; n=216) and emergency cardiology department of Saratov clinical hospital (CH; n=208). Results. The real practice in the audited hospitals are not fully consistent with current guidelines for the STEMI patients management. The relationship between guidelines compliance and hospital type is clearly seen. Doctors in MH in comparison with them in CH more often prescribed respiratory analeptics (13.4% vs 5.3% , respectively), metabolic drugs (63.4% vs 37.5%, respectively) and rarer used beta-blockers (50% vs 88.9%, respectively) and thrombolytic therapy (3.7% vs 51%, respectively). In MH dipyridamole was used in 9.6% of patients as an alternative to the acetylsalicylic acid, and clopidogrel was not prescribed. At the same hospital clotting time was determined for monitoring of heparin therapy. Statins were rare used in both hospitals (26% in MH vs 40% in CH). Conclusion. The real clinical practice of STEMI patients management in Saratov hospitals are not completely consistent with current clinical guidelines. There are differences in STEMI patients therapy depending on hospital type.
About the Authors
R. M. Magdeev
Saratov State Medical University
Russian Federation
Russian Federation
O. V. Reshetko
Saratov State Medical University
Russian Federation
Russian Federation
E. Y. Rudnichenko
Saratov State Medical University
Russian Federation
Russian Federation
N. V. Furman
Saratov Research Institute for Cardiology
Russian Federation
Russian Federation
P. V. Dolotovskaya
Saratov Research Institute for Cardiology
Russian Federation
Russian Federation
T. Y. Grozdova
Regional Fund of Compulsory Health Insurance of Saratov Region
Russian Federation
Russian Federation
L. N. Volkova
Regional Fund of Compulsory Health Insurance of Saratov Region
Russian Federation
Russian Federation
References
1. Диагностика и лечение больных острым инфарктом миокарда с подъемом сегмента ST электрокардиограммы. Российские рекомендации. Разработаны Комитетом экспертов Всероссийского научного общества кардиологов 2007. htpp://www.cardiosite.ru
2. Antman E.M., Anbe D.T., Armstrong P.W. et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—executive summary: a report of the ACC/AHA Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines on the Management of Patients With Acute Myocardial Infarction. J Am Coll Cardiol 2004;44:671–719.
3. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. Eur Heart J 2008; 29: 2909-2945
4. Fox K.A.A., Goodman S.G., Klein W. et al. Management of acute coronary syndromes. Variations in practice and outcome: Findings from the Global Registry of the Acute Coronary Events (GRACE). Eur. Heart J 2002;23:1177-1189
5. Daly C., Clemens F., Lopez-Sendon J. L. et al. The impact of guideline compliant medical therapy on clinical outcome in patients with stable angina: findings from the Euro Heart Survey of stable angina. Eur Heart J 2006;27:1298–1304
6. Mandelzweig L., Battler A., Boyko V. et al. The second Euro Heart Survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J 2006;27:2285–2293
7. Fox K.A.A., Goodman S.G., Anderson F.A. et al. From guidelines to clinical practice: the impact of hospital and geographical characteristics on temporal trends in the management of acute coronary syndromes. The Global Registry of Acute Coronary Events (GRACE). Eur Heart J 2003;24:1414-1424
8. Hasdai D., Behar S., Wallentin L. et al. A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in European and Mediterranean basin: The Euro Heart Survey Acute Coronary Syndomes (Euro Heart Survey ACS). Eur. Heart J 2002; 23:1190-1201
9. Hordijk-Trion M., Lenzen M., Wijns W. et al, Patients enrolled in coronary intervention trials are not representative of patients in clinical practice: results from the Euro Heart Survey. Eur Heart J 2006; 27: 671– 678
10. Terkelsen C.J., Lassen J.F., Nrgaard B.L. et al Mortality rates in patients with ST-elevation vs. non-ST-elevation acute myocardial infarction: observations from an unselected cohort. Eur Heart J 2005; 26:18– 26
11. Widimsky P. Acute coronary syndromes registries. E-Journal — Volume 5 http://www.escardio.org/communities/councils/ccp/e-journal/volume5/Pages/vol5n40.aspx
12. Беленков Ю.Н., Мареев В.Ю. Как мы лечим больных с сердечно-сосудистыми заболеваниями в реальной клинической практике. Терапевтический архив, 2003, 8:5-11
13. Reed S.D., McMurray J.J.V., Velazquez E.J. et al. Geographic Variation in the Treatment of Acute Myocardial Infarction in the VALsartan In Acute myocardial iNfarcTion (VALIANT) Trial. Am Heart J 2006;152(3):500-508
14. Kramer J.M., Newby L.K., Chang W.-C. et al. International variation in the use of evidence-based medicines for acute coronary syndrome. Eur. Heart J 2003; 24:2133-2141
15. Tyde´n P., Hansen O., Janzon L. Intra-urban variations in incidence and mortality in myocardial infarction. A study from the myocardial infarction register in the city of Malmo¨, Sweden, Eur Heart J 1998;19:1795–1801
16. Giugliano R.P., Llevadot J., Wilcox R.G. et al. Geographic variation in patient and hospital characteristics, management, and clinical outcomes in ST-elevation myocardial infarction treated with fibrinolysis. Results from InTIME-II. Eur Heart J 2001; 22:1702–1715
17. Mitra S., Findley K., Frohnapple D., Mehta J.L. Trends in Long-Term Management of Survivors of Acute Myocardial Infarction by Cardiologists in a Government University-Affiliated Teaching Hospital. Clin. Cardiol. 2002;25:16–18
18. Gottwik M., Zahn R., Schiele R. et al Differences in treatment and outcome of patients with acute myocardial infarction admitted to hospitals with compared to without departments of cardiology Results from the pooled data of the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA 1+2) Registries and the Myocardial Infarction Registry (MIR) Euro Heart J 2001;22: 1794–1801
19. РешетькоО.В., Фурман Н.В., Магдеев Р.М.,. Довгалевский Я.П Фармакоэпидемиологический анализ реперфузионной терапии инфаркта миокарда с подъемом сегмента ST в стационарах различного типа Саратовской области. РФК 2009;6:7-12
20. Петров В.И., редактор. Прикладная фармакоэпидемиология. М.:ГЭОТАР-Медиа; 2008
21. Решетько О.В., Фурман Н.В., Магдеев Р.М. Структура назначений лекарственных препаратов в первые сутки стационарного лечения острого коронарного синдрома без подъёма сегмента SТ. РФК 2009;2:6-15
22. Явелов И.С., Грацианский Н.А. Российский регистр острых коронарных синдромов: лечение и исходы в стационаре при остром коронарном синдроме с подъемами сегмента ST. Кардиология 2004;4: 4-13
23. Стандарт медицинской помощи больным острым инфарктом миокарда. Приложение к приказу Министерства здравоохранения и социального развития Российской Федерации №548 от 06.09.2005 г.
Review
For citations:
Magdeev R.M., Reshetko O.V., Rudnichenko E.Y., Furman N.V., Dolotovskaya P.V., Grozdova T.Y., Volkova L.N. PHARMACOTHERAPY ANALYSIS OF ACUTE ST-ELEVATION MYOCARDIAL INFARCTION IN HOSPITALS OF VARIOUS TYPES. Rational Pharmacotherapy in Cardiology. 2011;7(6):733-738. (In Russ.) https://doi.org/10.20996/1819-6446-2011-7-6-733-738
Views: 584
Email this article 