rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2011-7-5-57-61rpcardio-900Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯTHE ADHERENCE TO RECOMMENDED THERAPY IN PATIENTS AFTER ACUTE CORONARY SYNDROME, AND RISK OF CARDIOVASCULAR COMPLICATIONS WITHIN A YEAR AFTER HOSPITAL ADMISSIONПРИВЕРЖЕННОСТЬ РЕКОМЕНДОВАННОЙ ТЕРАПИИ БОЛЬНЫХ, ПЕРЕНЕСШИХ ОСТРЫЙ КОРОНАРНЫЙ СИНДРОМ, И РИСК РАЗВИТИЯ СЕРДЕЧНО-СОСУДИСТЫХ ОСЛОЖНЕНИЙ В ТЕЧЕНИЕ ГОДА ПОСЛЕ ГОСПИТАЛИЗАЦИИПучиньянН. Ф.Puchin'yanN. F.

к.м.н., мл.н.с. лаборатории атеросклероза 

puchin@yandex.ruДовгалевскийЯ. П.DovgalevskiyYa. P.

д.м.н., зав. лаборатории атеросклероза

ДолотовскаяП. В.DolotovskayaP. V.

к.м.н., мл.н.с. лаборатории неотложной кардиологии

ФурманН. В.FurmanN. V.

к.м.н., зав. лаборатории неотложной кардиологии

Саратовский Научно-исследовательский институт кардиологииРоссияSaratov Research Institute for CardiologyRussian Federation20111901201675567573Copyright © Puchin'yan N.F., Dovgalevskiy Y.P., Dolotovskaya P.V., Furman N.V., 20162016Пучиньян Н.Ф., Довгалевский Я.П., Долотовская П.В., Фурман Н.В.Puchin'yan N.F., Dovgalevskiy Y.P., Dolotovskaya P.V., Furman N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/900

Aim. In patients after acute coronary syndrome (ACS) to study the effect of adherence to recommended therapy on the risk of cardiovascular events during a year after hospital admission, and to identify the main causes of low adherence to prescribed therapy. Material and methods. Patients with ACS (n=271), consistently admitting to the emergency cardiology department were included into the study. Complex therapy (acetylsalicylic acid (ASA), beta-blockers (BB), ACE inhibitors, statins) was prescribed to all patients. The drugs prescription rate was analyzed. The cardiovascular events (death, myocardial infarction, stroke, episodes of unstable angina, decompensated heart failure) were recorded for 12 months. The adherence of patients to recommended therapy was evaluated. Results. After hospital discharge ASA therapy was recommended to 98% of patients, BB — 95%, ACE inhibitors — 97%, statins — 63%. In 12 months only 73% of patients continued therapy with ASA, 66% — BB, 74% — ACE inhibitors, 44% — statins. The rate of hospital re-admission was significantly higher in patients with low adherence: 80% (n=32) vs 24% (n=55) among compliant patients. The main causes of hospital re-admission were decompensated heart failure (46%), recurrent episodes of angina (32%) or ACS (19%). Conclusion. A significant part of patients (about 1/3) terminates the recommended therapy within 12 months after ACS. Low adherence to therapy is often determined by subjective factors and associated with a 3-fold increased risk of cardiovascular events (RR 3.27; 95% CI 2.49-4.30; p=0.05).

Цель. Изучить влияние приверженности рекомендованной терапии пациентов, перенесших ОКС, на риск развития сердечно-сосудистых осложнений в течение одного года после госпитализации; выявить основные причины низкой приверженности предписанной терапии. Методы исследования. В исследование включены пациенты с ОКС (n=271), последовательно поступавшие в отделение неотложной кардиологии. Всем пациентам проводили комплексную терапию (ацетилсалициловая кислота (АСК), бета-адреноблокаторы (БАБ), ингибиторы АПФ, статины). Анализировали частоту назначения препаратов, потенциально улучшающих прогноз ИБС. В течение 12 мес отслеживали развитие сердечно-сосудистых осложнений (смерть, инфаркт миокарда, инсульт , эпизоды нестабильной стенокардии, декомпенсация сердечной недостаточности). Оценивали приверженность пациентов рекомендованной терапии. Результаты. При выписке из стационара терапия АСК была рекомендована 98% пациентам, БАБ — 95%, ингибиторами АПФ — 97%, статинами — 63%. Через 12 мес только 73% пациентов продолжили терапию АСК, 66% — БАБ, 74% — ингибиторами АПФ, 44% — статинами. Среди пациентов, прерывавших прием рекомендованных препаратов, частота повторных госпитализаций была достоверно выше: 80% (n=32) против 24% (n=55) среди приверженных терапии пациентов. Основными причинами госпитализаций становились декомпенсированная форма сердечной недостаточности (46%), возобновление клиники стенокардии напряжения (32%), повторные случаи ОКС (19%). Заключение. Значимая часть пациентов (около 1/3) прекращает рекомендованную терапию в течение 12 мес после развития ОКС. Низкая приверженность терапии, чаще всего обусловленная субъективными причинами, ассоциируется с трехкратным повышением риска развития сердечно-сосудистых осложнений (относительный риск=3,27; 95% ДИ 2,49–4,30; p=0,05).

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The authors declare that there are no conflicts of interest present.