Therapy » Estimation of the efficacy of therapy at the outpatient-polyclinic stage of observation in patients who have suffered from acute myocardial infarction (according to the PROFILE-IM register data)

Estimation of the efficacy of therapy at the outpatient-polyclinic stage of observation in patients who have suffered from acute myocardial infarction (according to the PROFILE-IM register data)

DOI: https://dx.doi.org/10.18565/therapy.2024.9.23-31

Kalaydzhyan E.P., Kutishenko N.P., Lukina Yu.V., Sichinava D.P., Martsevich S.Yu., Drapkina O.M.
1) National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia, Moscow; 2) City Polyclinic No. 9 of the Department of Healthcare of Moscow

Abstract. Providing the quality and efficacy of drug therapy for patients during the 1st year after myocardial infarction (MI) leads to reduced risk of cardiovascular complications (CVC) and increased quality of life (QOL) for them.
The aim: to estimate the quality of therapy in patients after MI in terms of achieving target performance indicators during the 1st year.
Material and methods. PROFILE-MI prospective register included patients discharged from the hospital after MI event. Observation period was 1 year, visits were made every 2 months, the criterion for the efficacy of therapy was achieving target blood pressure (BP < 130/80 mm Hg), heart rate (HR 60–70 beats per minute at rest), and lipid spectrum parameters (low-density lipoprotein cholesterol, LDL < 1.8 mmol/l). A visual analogue scale was used to assess the life quality (QOL).
Results. The study involved 160 individuals: 106 male (66.2%) and 54 female patients (33.8%), aged 74.2 ± 11.2 years [33; 87]. Maximum daily doses of the main groups of drugs were not achieved in the treatment of these patients. At the 1st visit, only 46.9% of participants had target BP values, after a year of observation – in 34.7% (p = 0.001). Target HR values at the 1st visit were fixed in 31.9% of patients, after a year of observation – in 53.7%, (p < 0.001). Target total cholesterol values at the 1st visit were fixed in 11.8% of patients, after a year – in 41.4% (p < 0.001). The frequency of LDL determination did not exceed 30%. The average daily dose of statins was 20 mg for all drugs in this group. Life quality (QOL) indexes did not exceed 7 points on average (according to a 10-point scale).
Conclusion. According to the PROFILE-IM registry data, in real clinical practice, when treating patients after MI, the potential for therapy aimed at reducing CVC and increasing QOL is not fully realized. Patients were prescribed medium or low doses of drugs, which led to unsatisfactory indexes of achieving blood pressure, heart rate and lipid spectrum parameters, as well as to low level of QOL.

Keywords: efficacy of treatment of myocardial infarction, target indicators, end point, outpatient register, acute myocardial infarction

Read entire article

Literature

1. Virani S.S., Alonso A., Aparicio H.J.; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics – 2021 update: A report from the American Heart Association. Circulation. 2021; 143(8): e254–e743.

https://doi.org/10.1161/CIR.0000000000000950. PMID: 33501848.

2. Погосова Н.В., Оганов Р.Г., Бойцов С.А. с соавт. Медикаментозная терапия у пациентов с ишемической болезнью сердца в России и Европе: результаты российской части международного многоцентрового исследования EUROASPIRE IV. Кардиология. 2016; 56(12): 11–19. (Pogosova N.V., Oganov R.G., Boitsov S.A. et al. Drug therapy in patients with ischemic heart disease in Russia and Europe: The results of the Russian part of the international multicentre study EUROASPIRE IV. Kardiologiya = Cardiology. 2016; 56(12): 11–19 (In Russ.)).

https://doi.org/10.18087/cardio.2021.8.n1650. PMID: 28290799. EDN: XIMNZN.

3. Драпкина О.М., Концевая А.В., Калинина А.М. с соавт. Профилактика хронических неинфекционных заболеваний в Российской Федерации. Национальное руководство 2022. Кардиоваскулярная терапия и профилактика. 2022; 21(4): 5–232. (Drapkina O.M., Kontsevaya A.V., Kalinina A.M. et al. 2022 prevention of chronic non-communicable diseases in of the Russian Federation. National guidelines. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2022; 21(4): 5–232 (In Russ.)).

https://doi.org/10.15829/1728-8800-2022-3235. EDN: DNBVAT.

4. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021; 42(34): 3227–337.

https://doi.org/10.1093/eurheartj/ehab484. PMID: 34458905.

5. Навасардян А.Р., Марцевич С.Ю. Конечные точки: виды, особенности выбора, интерпретация полученных результатов на примере кардиологических исследований. Кардиоваскулярная терапия и профилактика 2022; 21(5): 79–90. (Navasardyan A.R., Martsevich S.Yu. Endpoints: Types, selection, interpretation of the results obtained on the example of cardiology studies. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2022; 21(5): 79–90 (In Russ.)).

https://doi.org/doi:10.15829/1728-8800-2022-3243. EDN: EXNOOK.

6. Mitkowski P., Witkowski A., Stępińska J. et al. Position of the Polish Cardiac Society on therapeutic targets for LDL cholesterol concentrations in secondary prevention of myocardial infarctions. Kardiol Pol. 2023; 81(7–8): 818–23.

https://doi.org/10.33963/KP.a2023.0162. PMID: 37489830.

7. Sabouret P., Puymirat E., Kownator S. et al. Lipid-lowering treatment up to one year after acute coronary syndrome: Guidance from a French expert panel for the implementation of guidelines in practice. Panminerva Med. 2023; 65(2): 244–49.

https://doi.org/10.23736/S0031-0808.22.04777-2. PMID: 36222543.

8. Малай Л.Н., Солохина Л.В., Бухонкина Ю.М. с соавт. Характеристика больных и госпитальные исходы у пациентов с острым инфарктом миокарда: данные регистра (г. Хабаровск). Часть 1. Рациональная фармакотерапия в кардиологии. 2016; 12(1): 56–62. (Malay L.N., Solokhina L.V., Bukhonkina Yu.M. et al. Characteristic features, treatment and hospital outcomes in patients with acute myocardial infarction: Khabarovsk Register data. Part I. Ratsional’naya farmakoterapiya v kardiologii = Rational Pharmacotherapy in Cardiology. 2016; 12(1): 56–62 (In Russ.)).

https://doi.org/10.20996/1819-6446-2016-12-1-56-62. EDN: VRCVIP.

9. Малай Л.Н., Давидович И.М., Солохина Л.В., Пошатаев К.Е. Хабаровский регистр острого инфаркта миокарда: лечение и исходы в период пребывания в региональном сосудистом центре. Дальневосточный медицинский журнал. 2017; (1): 6–10. (Malay L.N., Davidovich I.M., Solokhina L.V., Poshataev K.E. Кhabarovsk register of acute myocardial infarction: Therapy and hospital outcomes during stay in the regional vascular center. Dal’nevostochnyy meditsinskiy zhurnal = Far East Medical Journal. 2017; (1): 6–10 (In Russ.)). EDN: YIXORN.

10. Давидович И.М., Малай Л.Н., Кутишенко Н.П. Отдаленные результаты и приверженность терапии у пациентов после острого инфаркта миокарда: данные регистра (Хабаровск). Клиницист. 2017; 11(4–1): 36–44. (Davidovich I.M., Malay L.N., Kutishenko N.P. The analysis of long-term outcomes and adherent to treatment in patients after myocardial infarction: Khabarovsk register data. Klinitsist = The Clinician. 2017; 11(4–1): 36–44 (In Russ.)).

https://doi.org/10.17650/1818-8338-2016-10-4-36-44. EDN: ZHGDPN.

11. Ягудина Р.И., Чибиляев В.А. Использование конечных и суррогатных точек в фармакоэкономических исследованиях. Фармакоэкономика. Современная фармакоэкономика и фармакоэпидемиология. 2010; 3(2): 12–18. (Yagudina R.I., Chibilyaev V.A. Сlinical and surrogate endpoints application in pharmacoeconomic researches. Farmakoekonomika. Sovremennaya farmakoekonomika i farmakoepidemiologiya = Pharmacoeconomics. Modern Pharmacoeconomics and Pharmacoepidemiology. 2010; 3(2): 12–18 (In Russ.)). EDN: MUDQUD.

12. Лазебник Л.Б., Гусеин-Заде М.Г., Ефремов Л.И. Выбор «суррогатных» и «конечных точек» в оценке эффективности медицинских вмешательств. Экспериментальная и клиническая гастроэнтерология. 2011; (8): 73–79. (Lazebnik L.B., Gusein-Zade M.G., Efremov L.I. Selection of “surrogate” and “endpoints” evaluation of the efficacy of medical interventions. Eksperimental’naya i klinicheskaya gastroenterologiya = Experimental and Clinical Gastroenterology. 2011; (8): 73–79 (In Russ.)). PMID: 22629760. EDN: TBZEHX.

13. Марцевич С.Ю., Кутишенко Н.П., Сичинава Д.П. с соавт. Проспективный амбулаторный регистр больных, перенесших острый инфаркт миокарда (ПРОФИЛЬ-ИМ): дизайн исследования и первые результаты. Кардиоваскулярная терапия и профилактика. 2018; 17(1): 81–86. (Martsevich S.Yu., Kutishenko N.P., Sichinava D.P. et al. Prospective outpatient registry of myocardial infarction patients (PROFILE-MI): Study design and first results. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2018; 17(1): 81–86 (In Russ.)).

https://doi.org/10.15829/1728-8800-2018-1-81-86. EDN: YQVNHE.

14. Пучиньян Н.Ф., Довгалевский Я.П., Долотовская П.В., Фурман Н.В. Приверженность рекомендованной терапии больных, перенесших острый коронарный синдром, и риск развития сердечно-сосудистых осложнений в течение года после госпитализации. Рациональная фармакотерапия в кардиологии. 2011; 7(5): 567–573. (Puchin’yan N.F., Dovgalevskiy Ya.P., Dolotovskaya P.V., Furman N.V. The adherence to recommended therapy in patients after acute coronary syndrome, and risk of cardiovascular complications within a year after hospital admission. Ratsional’naya farmakoterapiya v kardiologii = Rational Pharmacotherapy in Cardiology. 2011; 7(5): 567–573 (In Russ.)).

https://doi.org/10.20996/1819-6446-2011-7-5-57-61. EDN: OPQEVJ.

15. Fleming T.R., DeMets D.L. Surrogate end points in clinical trials: Are we being misled? Ann Intern Med. 1996; 125(7): 605–13.

https://doi.org/10.7326/0003-4819-125-7-199610010-00011. PMID: 8815760.

16. Бойцов С.А., Лукьянов М.М., Якушин C.С. с соавт. Амбулаторно-поликлинический регистр РЕКВАЗА: данные проспективного наблюдения, оценка риска и исходы у больных с кардиоваскулярными заболеваниями. Кардиоваскулярная терапия и профилактика. 2015; 14(1): 53–62. (Boitsov S.А., Lukyanov М.М., Yakushin S.S. et al. The outpatient based registry RECVASA: Prospective follow-up data, risk evluation and outcomes in cardiovascular patients. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2015; 14(1): 53–62 (In Russ.)).

https://doi.org/10.15829/17288800201515362. EDN: TLAOXR.

17. Singh B.N. Morbidity and mortality in cardiovascular disorders: Impact of reduced heart rate. J Cardiovasc Pharmacol Ther. 2001; 6(4): 313–31.

https://doi.org/10.1177/107424840100600401. PMID: 11907634.

About the Autors

Elena P. Kalaydzhyan, MD, PhD (Medicine), researcher at the Laboratory of pharmacoepidemiological studies of the Department of preventive pharmacotherapy, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101990, Moscow, 10/3 Petroverigsky Lane.
E-mail: yarlenok@yandex.ru
ORCID: https://orcid.org/0000-0003-1337-6499
Natalya P. Kutishenko, MD, Dr. Sci. (Medicine), head of the Laboratory of pharmacoepidemiological studies of the Department of preventive pharmacotherapy, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101990, Moscow, 10/3 Petroverigsky Lane.
E-mail: nkutishenko@gnicpm.ru
ORCID: https://orcid.org/0000-0001-6395-2584
Yulia V. Lukina, MD, Dr. Sci. (Medicine), leading researcher at the Laboratory of pharmacoepidemiological studies of the Department of preventive pharmacotherapy, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101990, Moscow, 10/3 Petroverigsky Lane.
E-mail: yuvlu@mail.ru
ORCID: https://orcid.org/0000-0001-8252-3099
David P. Sichinava, MD, PhD (Medicine), deputy chief physician for clinical and expert work, City Polyclinic No. 9 of the Department of Healthcare of Moscow. Address: 109451, Moscow, 4/2 Perervinsky Boulevard.
E-mail: dato-s86@yandex.ru
ORCID: https://orcid.org/ 0000-0002-7399-5315
Sergey Yu. Martsevich, MD, Dr. Sci. (Medicine), professor, head of the Department of preventive pharmacotherapy, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101990, Moscow, 10/3 Petroverigsky Lane.
E-mail: sergeymartsevich@mail.ru
ORCID: https://orcid.org/0000-0002-7717-4362
Oksana M. Drapkina, MD, Dr. Sci. (Medicine), professor, academician of RAS, director of National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101990, Moscow, 10/3 Petroverigsky Lane.
E-mail: ODrapkina@gnicpm.ru
ORCID: https://orcid.org/0000-0002-4453-8430

Estimation of the efficacy of therapy at the outpatient-polyclinic stage of observation in patients who have suffered from acute myocardial infarction (according to the PROFILE-IM register data)

Literature

About the Autors

Similar Articles