Clinical characteristics and analysis of pharmacotherapy of patients with atrial fibrillation and ishemic heart disease in outpatient practice according to the data of the REKUR-AF study


DOI: https://dx.doi.org/10.18565/therapy.2021.2.50-55

Polshakova I.L., Povetkin S.V.

Kursk State Medical University of the Ministry of Healthcare of Russia
Abstract. Objective: to study the clinical portrait, quality of diagnosis and treatment of patients with atrial fibrillation (AF) and coronary heart disease (CHD) in outpatient settings according to the data of the REKUR-AF study.
Material and methods. The study included 469 patients (52% men), with an average age of 71 [63–78] years. Permanent AF was detected in 55,0% of patients, paroxysmal in 20,2%, and persistent in 24,8% of the subjects. 43,3% of patients suffered a myocardial infarction.
Results. Combined cardiovascular pathology was found in the majority of patients (chronic heart failure – 98,9%, arterial hypertension – 93,8%, brain stroke – 13,0% etc.). Of the comorbidities, chronic kidney disease – 51,2%, diabetes – 21,7%, and obesity – 30,9% were most often registered. In the year preceding inclusion in the study, patients with AF and CHD were treated inpatient 1 [0–1] times a year, the most frequent causes of which were decompensation of chronic heart failure and destabilization of CHD – 37,3% and 23,1%, respectively. The average risk of thromboembolic complications on the CHA2DS2VASc scale in all patients with AF and CHD was 5 [3–5] points, and on the HAS-BLED scale – 3 [2–4] points. The frequency of prescribing laboratory diagnostic methods varied from 4% to 95%. The most commonly prescribed groups of drugs are angiotensin converting enzyme inhibitors (69,3%), beta-blockers (69,9%), antiplatelet agents (74,6%). Only 16,2% of patients used oral anticoagulants.
Conclusion. In the framework of the RECUR-AF study, it was found that patients with AF and CHD are characterized by an elderly age, the presence of a predominantly permanent form of AF, a significant level of combined cardiac and comorbidities, as well as a high risk of cardiovascular complications. The quality of the diagnostics and treatment performed does not fully meet the requirements of modern national recommendations.
Keywords: Key worlds: atrial fibrillation, coronary heart disease, pharmacotherapy for cardiovascular diseases
Read entire article

Literature


  1. HEARTS: комплекс практических мер по ведению пациентов с сердечно-сосудистыми заболеваниями на уровне первичной медико-санитарной помощи. Женева: Всемирная организация здравоохранения. 2018: 63. Доступ: https://apps.who.int/iris/bitstream/handle/10665/311510/9789244511374-rus.pdf?ua=1 (дата обращения – 01.02.2021). [HEARTS: technical package for cardiovascular disease management in primary health care. Geneva: World Health Organization. 2018: 63 Available at: https://apps.who.int/iris/bitstream/handle/10665/311510/9789244511374-rus.pdf?ua=1 (date of access – 01.02.2021) (In Russ.)].

  2. Рейтинг стран мира по уровню валового внутреннего продукта. Гуманитарная энциклопедия: Исследования [Электронный ресурс]. Центр гуманитарных технологий. 2006–2020 (последняя редакция: 16.08.2020). Доступ: https://gtmarket.ru/ratings/rating-countries-gdp/rating-countries-gdp-info (дата обращения – 01.02.2021). [Rating of the world’s countries by the level of gross domestic product. Humanitarian encyclopedia: Research [Electronic resource]. Center for humanitarian technologies, 2006–2020 (last edition: 16.08.2020). Available at: https://gtmarket.ru/ratings/rating-countries-gdp/rating-countries-gdp-info (date of access – 01.02.2021) (In Russ.)].

  3. Остроумова О.Д., Кочетков А.И., Орлова И.Ю. с соавт. Подходы к выбору антикоагулянтной терапии в лечении больного с сочетанием фибрилляции предсердий, ишемической болезни сердца и периферического атеросклероза: возможности апиксабана. Рациональная фармакотерапия в кардиологии. 2018; 3: 441–450. [Ostroumova O.D., Kochetkov A.I., Orlova I.Yu. et al. Approaches to the choice of anticoagulant therapy in the treatment of patients with combination of atrial fiblillation with coronary heart disease or peripheral atherosclerosis: potential of apixaban. Ratsional'naya farmacotherapiya v kardiologii = Rational pharmacotherapy in cardiology. 2018; 3: 441–450 (In Russ.)]. doi: https://doi.org/10.20996/1819-6446-2018-14-3-441-450.

  4. Theodorakis G.Ν. Coronary artery disease and atrial fibrillation. Hellenic J Cardiol. 2017; 58(3): 213–14. doi: 10.1016/j.hjc.2017.09.002.

  5. Yasuda S., Kaikita K., Akao M. et al. Antithrombotic therapy for atrial fibrillation with stable coronary disease. N Engl J Med. 2019; 381(12): 1103–13. doi:10.1056/NEJMoa1904143.

  6. 2019 Рекомендации ЕSC по диагностике и лечению хронического коронарного синдрома. Российский кардиологический журнал. 2020; 2: 119–182. [2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Rossiyskiy kardiologicheskiy zhurnal = Russian journal of cardiology. 2020; 2: 119–182 (In Russ.)]. doi: https://doi.org/10.15829/1560-4071-2020-2-3757.

  7. Клинические рекомендации «Диагностика и лечение фибрилляции предсердий». Всероссийское научное общество специалистов по клинической электрофизиологии, аритмологии и электрокардиостимуляции в сотрудничестве с Российским кардиологическим обществом и Ассоциацией сердечно-сосудистых хирургов России. Доступ: https://vnoa.ru/upload/edition_june2017/4_fp.pdf (дата обращения – 01.02.2021). [Clinical guidelines: Diagnosis and treatment of atrial fibrillation. All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Pacing in cooperation with the Russian Society of Cardiology and the Association of Cardiovascular Surgeons of Russia. Available at: https://vnoa.ru/upload/edition_june2017/4_fp.pdf (date of access – 01.02.2021) (In Russ.)].

  8. Рекомендации ESC по лечению пациентов с фибрилляцией предсердий, разработанные совместно с EACTS. Российский кардиологический журнал. 2017; 7: 7–86. [ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Rossiyskiy kardiologicheskiy zhurnal = Russian journal of cardiology. 2017; 7: 7–86 (In Russ.)]. doi: https://doi.org/10.15829/1560-4071-2017-7-7-86.

  9. Michniewicz E., Mlodawska E., Lopatowska P. et al. Patients with atrial fibrillation and coronary artery disease – double trouble. Adv Med Sci. 2018; 63(1): 30–35. doi:10.1016/j.advms.2017.06.005.

  10. Becker R.C. Antithrombotic therapy in atrial fibrillation and coronary artery disease. N Engl J Med. 2019; 381(12): 1169–70. doi:10.1056/NEJMe1910560.

  11. Михин В.П., Масленникова Ю.В., Лукьянов М.М. Структура госпитализации и антитромботическая терапия у больных с фибрилляцией предсердий в сочетании с ишемической болезнью сердца (данные регистра РЕКВАЗА ФП-Курск). Архивъ внутренней медицины. 2017; 3: 217–223. [Mikhin V.P., Maslennikova Y.V., Loukianov M.M. Peatients with atrial fibrillation and ishemic heart disease: hospitalization structure and antitrombotic therapy (RECVASA AF-Kursk registry). Arkhiv vnutrenney meditsiny = Archive of internal medicine. 2017; 3: 217–223 (In Russ.)]. doi: https://doi.org/10.20514/2226-6704-2017-7-3-217-223.

  12. Михин В.П., Масленникова Ю.В., Лукьянов М.М., Кудряшов Е.В. Медикаментозная терапия больных ишемической болезнью сердца в сочетании с фибрилляцией предсердий в реальной медицинской практике (результаты регистра РЕКВАЗА ФП-Курск). Курский научно-практический вестник «Человек и его здоровье». 2017; 2: 49–54. [Mikhin V.P., Maslennikova Y.V., Lukyanov M.M., Kudryashov E.V. Drug therapy in patients with coronary heart disease in combination with atrial fibrillation in real medical practice (results of RECVASA AF-Kursk registry). Kurskiy nauchno-prakticheskiy vestnik «Chelovek i ego zdorov'e» = Kursk scientific and practical bulletin «Human and His Health». 2017; 2: 49–54 (In Russ.)]. doi: https://doi.org/10.21626/vestnik/2017-2/09.

  13. Рубаненко О.А. Коморбидная патология у пациентов с фибрилляцией предсердий. Известия Самарского научного центра Российской академии наук. 2015; 2: 367–70. [Rubanenko O.A. Comorbid pathology in patients with atrial fibrillation. Izvestiya Samarskogo nauchnogo tsentra Rossijskoy akademii nauk = Bulletin of the Samara Scientific Center of the Russian Academy of Sciences. 2015; 2: 367–70 (In Russ.)].

  14. Баллюзек М.Ф., Александрова Л.Н. Частота и особенности течения ишемической болезни сердца, ассоциированной с развитием фибрилляции предсердий. Вестник Санкт-Петербургского университета. 2012; 2: 3–9. [Ballyuzek M.F., Aleksandrova L.N. Frequency and features of the course of ischemic heart disease associated with the development of atrial fibrillation. Vestnik Sankt-Peterburgskogo universiteta = Saint Petersburg University Bulletin. 2012; 2: 3–9 (In Russ.)].

  15. Lip G.Y., Laroche C., Dan G.A. et al. A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry. Europace. 2014; 16(3): 308–19. doi: 10.1093/europace/eut373.

  16. Fischer Q., Georges J.L., Le Feuvre C. et al. Optimal long-term antithrombotic treatment of patients with stable coronary artery disease and atrial fibrillation: «OLTAT registry». Int J Cardiol. 2018; 264: 64–69. doi:10.1016/j.ijcard.2018.03.018.


About the Autors

Inna L. Polshakova, assistant of the Department of clinical pharmacology, Kursk State Medical University of the Ministry of Healthcare of Russia. Address: 305041, Kursk, 3 K. Marx Str. Tel.: +7 (920) 72-86-44. E-mail: potolowa@mail.ru. ORCID: 0000-0002-5083-3137
Sergey V. Povetkin, MD, professor, head of the Department of clinical pharmacology, Kursk State Medical University of the Ministry of Healthcare of Russia. Address: 305041, Kursk, 3 K. Marx Str. Tel.: +7 (4712) 70-39-82. E-mail: psv46@kursknet.ru. ORCID: 0000-0002-1302-9326

Back to Content

Бионика Медиа