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Rational Pharmacotherapy in Cardiology

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Vol 10, No 4 (2014)
View or download the full issue PDF (Russian)
https://doi.org/10.20996/1819-6446-2014-10-4

ORIGINAL STUDIES

366-377 680
Abstract

Aim. To study the structure of risk factors and associated cardiovascular and concomitant non-cardiac diseases in patients with atrial fibrillation (AF) on the base of the data of registry, and to estimate diagnostics and treatment quality in real outpatient practice in the Ryazan region with high cardiovascular mortality rate.

Material and methods. A total of 3690 patients with AF, arterial hypertension (HT), ischemic heart disease (IHD) and chronic heart failure (CHF) consulted by general practitioners and cardiologists in three outpatient clinics of Ryazan, were enrolled into the outpatient REgistry of CardioVAScular diseAses (RECVASA). 530 of 3690 (14.4%) patients had the "atrial fibrillation" diagnosis in their outpatient charts: 175 (33.0%) men, 355 (67.0%) women, and mean age – 72.3±10.1 years.

Results. Permanent, paroxysmal or persistent forms of AF were indicated in outpatient charts of 43.2%, 26.4% and 24.7% of 530 AF patients, respectively, and 5.7% of outpatient charts did not specify AF form. All the AF patients had associated cardiovascular diseases (HT and/or IHD and/or CHF). The history of myocardial infarction, stroke and diabetes was revealed in 20.2%, 14.9% and 21.1% of patients, respectively. Revealed level of diagnostics did not satisfy adequate standard of examination with such cardiac pathology. Prescription of necessary drugs of some groups was insufficient, although indications existed. At the time of being included into the registry only 15.2% of AF patients received cardio-vascular drugs at a privileged price compared to 39.2% in the preceding years (p<0.05). AF diagnosis was confirmed in 84.2% of 76 randomly selected patients at its validation.

Conclusion. The RECVASA research revealed high incidence of cardiac comorbidity in patients with the AF, underestimation of cardiovascular risk factors, insufficient use of diagnostic tests and prescription of some drug groups recommended by national and international guidelines.

378-383 701
Abstract

Aim. To assess the quality of arterial hypertension (HT) pharmacotherapy within the outpatient register RECVASA, emphasizing whether the choice of antihypertensive drugs (AHD) is in line with current clinical guidelines.

Material and methods. Patients with HT without ischemic heart disease, chronic heart failure and atrial fibrillation (n=741) were selected from all patients (n=3690) included into the register. Among concomitant diseases were revealed the following: bronchial asthma and/or chronic obstructive pulmonary disease (COPD) – in 42 (5.7%) patients; obesity – in 93 patients, impaired glucose tolerance – in 9 patients, and diabetes mellitus – 84 patients. Prescription of AHD, their number and class were recorded at every next visit to doctor. Accuracy of AHD choice, compliance with current clinical guidelines, and other considerations were assessed through the example of beta-blockers (BBs).

Results. AHD were prescribed to 641 patients, and in 13.5% of patients did not receive any AHD. 49.7% of patients received ACE inhibitors, 38.5% – diuretics, 32.5% – BBs. BBs were prescribed to the third part of patients with diabetes and obesity. Furthermore a quarter patients with COPD and the third part of patients with bronchial asthma received BBs. BBs in combination with thiazide diuretics were prescribed to 12 (41.4%) patients with diabetes mellitus and to 13 (40.6%) patients with obesity.

Conclusion. Doctors do not always make AHD choice according to current clinical guidelines. Compliance of AHD choice with current clinical guidelines should be an element of treatment quality assessment.

384-390 683
Abstract

Aim. To pursue pharmacoeconomic analysis of two drug combinations of ACE inhibitor (enalapril) and diuretic.

Material and methods. Patients with arterial hypertension degree 2 and diabetes mellitus type 2 without ischemic heart disease (n=56) were included into the study. Blood pressure (BP) dynamics and cost/effectiveness ratio were evaluated.

Results. In group A (fixed combination of original enalapril/hydrochlorothiazide) 61% of patients achieved target BP level with initial dose, and the rest 39% of patients – with double dose. In group B (non-fixed combination of generic enalapril/indapamide) 60% of patients achieved the target BP with initial dose of drugs, 33% - with double dose of ACE inhibitor, and 7% - with additional amlodipine administration. In patients of group A systolic BP (SBP) reduction was 45.82±1.23 mm Hg by the 12th week vs. 40.0±0.81 mm Hg in patients of group B; diastolic BP (DBP) reduction was 22.47±1.05 mm Hg and 18.76±0.70 mm Hg, respectively, by the 12th week of treatment. In the first month of treatment costs of target BP achievement was 298.62 rubles per patient in group A, and 299.50 rubles – in group B; by the 12th week of treatment – 629.45 and 631.22 rubles, respectively. Costs of SBP and DBP reduction by 1 mm Hg during 12 weeks of therapy were 13 and 27 rubles per patient, respectively, in group A, and 16 and 34 rubles per patient, respectively, in group B.

Conclusion. The original fixed combination (enalapril+hydrochlorothiazide) proved to be more clinically effective and more cost effective in the treatment of hypertensive patients in comparison with the non-fixed combination of generic drugs (enalapril+indapamide).

391-396 388
Abstract

Aim. To study the efficacy of antihypertensive therapy in elderly patients under the condition of research program and outpatient practice by ambulatory blood pressure (BP) monitoring (ABPM) and office BP evaluation, as well as explore patients' treatment compliance.

Material and methods. Patients with arterial hypertension, 1-2 degree (n=75) were included into the study. Patients were invited to in-person physician visit again after 4 years. Evaluation of office BP, ABPM, Morisky-Green questionnaire survey was performed. Besides patients were asked to give their understanding of factors that could influence treatment compliance. Patients were divided into 2 cohorts (adherers and non-adherers), depending on the results of Morisky-Green questionnaire survey.

Results. Contact was got in 50 of 75 patients after 4 years. Only 10 of patients (20%) were compliant according to Morisky-Green questionnaire survey, and 13 patients (26%) revealed a high risk of non-compliance. 26 of patients (52%) forgot to take medications, 25 patients (50%) were inaccurate regarding time of drug administration. Some patients missed medicines taking when they were in good condition (58%), or they were unwell (36%) due to sharp BP decrease after taking drugs.

Conclusion. The patients' treatment compliance remains one of the most important problems of chronic diseases therapy. Only 20% of elderly hypertensive patients are compliant.

PAGES OF RUSSIAN NATIONAL SOCIETY OF EVIDENCE-BASED PHARMACOTHERAPY

397-401 419
Abstract

The most common ways of assessment of cardiovascular diseases treatment abroad, approaches to creation of such assessment methods are considered, as well as data on the principles of the assessment of treatment in Russia. Some foreign registers of acute myocardial infarction, the aim of which was therapy quality assessment, are given as examples. The problem of high-quality treatment based on data from evidence-based medicine, some legal aspects related to clinical guidelines in Russia are considered, as well as various ways of treatment quality assessment.

ASSOCIATED PROBLEMS OF CARDIOLOGY

402-405 303
Abstract

The theoretical foundations of the application of pharmacoeconomic evaluations of pharmacotherapies in order to improve their economic efficiency and support the process of taking decisions on their payment from public funds are examined. An algorithm is presented for the pharmacoeconomic audit, which is applicable for assessing the objectivity and reliability of the proposed pharmacoeconomic data from pharmaceutical manufacturers in the application process for inclusion in the positive list of medicines in Bulgaria and the reimbursement of economically rational pharmacotherapies from the public health fund.

406-410 406
Abstract

Aim. To study the features of piribedil use in the treatment of mild cognitive impairments in patients with chronic heart failure (CHF).

Material and methods. Open randomized study of piribedil efficacy in treatment of mild cognitive impairments of the patients with CHF and ischemic heart disease was performed. Eligible patients were randomized into group of piribedil treatment or control group. Each group included 20 patients. Patients of the main group received piribedil 50 mg a day during 12 weeks. Cognitive functions were estimated by Burdon’s test, 5 and 7 subtests of Wexler before and after 12 weeks of treatment.

Results. Significant improvement of cognitive tests was revealed in patients receiving piribedil at the final visit. Maximum effect of the drug was observed in younger patients, patients with increased carotid arteries intima-media thickness and increased left ventricular end-diastolic dimension.

Conclusion. Piribedil significantly improves memory and attention in patients with CHF and can be used in therapy of mild cognitive impairments in these patients.

NOTES FROM PRACTICE

411-415 494
Abstract

Topical issues of the treatment of hypertension in pregnancy are presented. Examples from clinical practice are discussed as well as possible medical treatment of hypertension in pregnant women taking into account actual recommendations.

416-420 349
Abstract

Strategies for the management of patients with atrial fibrillation (heart rhythm or heart rate control) are considered. The advantages of these methods, especially the implementation are presented. Based on their own data, authors give an algorithm to select the management strategy in particular patient. Preparation and implementation of electrical cardioversion procedure are described. The evidence base and analysis of complications of different anticoagulants use for safety of sinus rhythm restoration are presented.

421-424 491
Abstract

Aim. To study the dynamics of blood pressure (BP), heart rate (HR), the sympathetic-vagal balance in patients with arterial hypertension (HT) III stage after stroke during therapy based on bisoprolol 5-10 mg/day.

Material and methods. Patients (n=12) with HT stage III with stroke history were examined. Age of the patients was 62±7.4 years old. Laboratory tests, BP monitoring, evaluation of the ratio of low frequency (LF) and high frequency (HF) components of HR variability and average daily HR determination were performed in all patients at baseline, after 14 and 34 days after therapy initiation. Bisoprolol was administered at dose of 5-10 mg/day.

Results. BP decreased to the target level in all patients after 14 days of treatment and persisted through 34 days. Average daily HR and LF/HF ratio decreased, reaching the optimal values after 34 days. Significant dynamics in metabolic parameters and side effects were not found.

Conclusion. Target BP levels, a significant decrease in HR and sympathetic activity, increase in parasympathetic activity of the autonomic regulation occurred since 14-th day of therapy based on bisoprolol (5-10 mg/day). The received effects allowed patients to continue rehabilitation therapy, accompanied with physical exertion.

INNOVATIVE CARDIOLOGY

425-431 324
Abstract

Deep vein thrombosis and pulmonary embolism are an important medical and social problem, contributing to the structure of morbidity and mortality in the developed countries. Despite the availability of clinical guidelines for the prevention of venous thromboembolic complications there is a gap between scientific knowledge and clinical practice. Clinical decision support systems (CDSS) are confirmed to be effective tool for the implementation of clinical guidelines in daily practice. CDSS should be based on national and international clinical guidelines; their effectiveness depends upon successful integration with other health information systems and care flow processes.

POINT OF VIEW

432-437 322
Abstract

Prevention of thromboembolic complications in patients with atrial fibrillation during catheter pulmonary veins isolation is discussed. This subject review is presented with special consideration to new anticoagulants.

438-443 382
Abstract

The possibility of atorvastatin in reducing the risk of periprocedural myocardial infarction and other cardiovascular events in patients with percutaneous coronary intervention is discussed.

CURRENT QUESTIONS OF CLINICAL PHARMACOLOGY

444-447 337
Abstract

Comparative analysis of oral anticoagulants (vitamin K antagonists and new drugs, including dabigatran, rivaroxaban and apixaban) is presented from the standpoint of safety. The safety profile of the new oral anticoagulants is significantly better than vitamin K antagonists profile, but requires consideration of special clinical situations that predispose to an increased risk of bleeding.

448-456 980
Abstract

Review of clinical studies on the use of ethylmethylhydroxypyridine succinate (EMHPS) medications in patients with stroke and its consequences is presented. EMHPS drugs are widely used in routine clinical practice in Russia, despite the absence of clear evidence of neuroprotection in stroke. Most clinical studies of EMHPS drugs were small, nonrandomized and had "soft" endpoints. The results in many papers are presented without appropriate statistical comparisons. In many studies of EMHPS drugs different administration regimens were used that are often not described in the drug instructions and the federal guidelines. Correlation between EMHPS use and decreasing mortality after stroke was not shown in any of the studies. Existing studies have not provided compelling evidence for widespread clinical use of EMHPS drugs in patients with stroke and its consequences.

JUBILEE

457-458 181
Abstract

To the anniversary of Academician E.V. Shlyakhto.

459 150
Abstract

Congratulations to Professor N.V. Perova.

460 152
Abstract

Symposium devoted to the 10th anniversary of the journal “Rational Pharmacotherapy in Cardiology” “Advance in cardiovascular diseases prevention and management in the past decade”. September 25, 2014, Kazan.

461 146
Abstract

New age of postgraduate medical education.



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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)