Evaluation of Drug Therapy and Adherence to It in Patients after Acute Coronary Syndrome in Real Clinical Practice (Results of One Year Observation)

Aim. To study the prescribed drug therapy, as well as adherence to it in patients with acute coronary syndrome (ACS) in real clinical practice within a year after the index event. Material and methods. The study included 327 patients who were in hospital treatment with ACS: 199 patients (60.9%) with unstable angina (UA) and 128 (39.1%) – with acute myocardial infarction (AMI). The prescribed treatment and adherence to therapy were evaluated within 12 months after the coronary event. Therapy prescribed to patients was compared with current clinical guidelines for the treatment of patients with ACS. Results. 67% of patients completed the clinical study Adherence to prescribed medication within 12 months after ACS was maximal for ACE inhibitors/angiotensin receptor blockers (83.6%), dual antiplatelet therapy (79.9%) and β-blockers (78.1%), and minimal for lipid-lowering drugs (statins; 61.6%). A significant decrease in adherence was revealed in 6 and 12 months from the initiation of therapy. Significantly higher level of adherence to DAT was found in patients with AMI compared with patients with UA (p<0.05). When analyzing the frequency of occurrence of endpoints, it was found that patients who did not adhere to treatment significantly more often had hospitalizations due to UA (15.1% vs 7.4%; p<0.05), AMI (16.9% vs 8.1%; p<0.05), death from cardiovascular causes (13% vs 10.4%; p<0.05). Conclusion. Therapy prescribed at the outpatient stage in patients with ACS in the Rostov Region corresponds to the modern clinical recommendations. Six months after hospital discharge adherence to drug therapy in patients is reduced, which requires more careful outpatient monitoring during this period. In patients who are not adherent to treatment, cardiovascular complications are significantly more frequent.

1. Boytsov S.A., Nikulina N.N., Yakushin S.S. et al. High mortality rates from coronary heart disease in the Russian Federation: problems of statistical data (results of Russian multicenter epidemiological study of morbidity, mortality, quality of diagnosis and treatment of acute forms of ischemic heart disease - REZONANS). Serdtse. 2010;1(51):19-25. (In Russ.)

2. Boytsov S.A., Samorodskaya I.V., Nikulina N.N. et al. Comparative analysis of mortality from acute forms of ischemic heart disease during a 15-year period in the Russian Federation and the United States and the factors influencing its formation. Ter Arkhiv. 2017;89(9):53-9. (In Russ.). doi:10.17116/terarkh201789953-59.

3. Lukina Y.V., Ginzburg M.L., Smirnov V.P. et al. Treatment compliance, in patiens with acute coronary syndrom before hospitalization. Clinician. 2012;6(2):41-9 (In Russ.) doi:10.17650/1818-8338-2012-6-2-41-49.

4. Piepoli M.F., Hoes A.W., Agewall S. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37:2315-81. doi:10.1093/eurheartj/ehw106.

5. Kontsevaya A.V., Kalinina A.M., Koltunov I.E., Oganov R.G. Socio-economic damage by acute coronary syndrome in Russian Federation. Rational Pharmacotherapy in Cardiology. 2011;7(2):158-66 (In Russ.). doi:10.20996/1819-6446-2011-7-2-158-166.

6. Kuzheleva E.A., Borel' K.N., Garganeeva A.A. Low adherence to treatment after myocardial infarction: causes and ways of adjustment considering psycho-emotional state of patients. Rational Pharmacotherapy in Cardiology. 2016;12(3):291-5 (In Russ.) doi:10.20996/1819-6446-2016-12-3-291-295.

7. Shalnova S.A., Konradi A.O., Karpov Yu. A., et al. Cardiovascular mortality in 12 Russian Federation regions - participants of the “Cardiovascular Disease Epidemiology in Russian Regions” study. Russ J Cardiol. 2012;5(97):6-11 (In Russ.)

8. Martsevich S.Yu., SemenovaYu.V., Kutishenko N.P. et al. LIS-3 Register of the Acute Coronary Syndrome: what has Changed in a "Portrait" of a Patient and Short-Term Outcomes of the Disease Compared to LIS-1 Register. Rational Pharmacotherapy in Cardiology. 2017;13(1):63-8. (In Russ.) doi:10.20996/1819-6446-2017-13-1-63-68.

9. Kotseva K., Wood D., De Backer G., et al. EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from twenty four European countries. Eur J Prev Cardiol. 2016;23(6):636-48. doi:10.1177/2047487315569401.

10. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39(3):213-60. doi:10.1093/eurheartj/ehx419.

11. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. doi: 10.1093/eurheartj/ehx393.

12. Pchelintsev M.V., Belousov D.Y. Pharmacoepidemiology of acute coronary syndrome. Domestic analysis of the actual prescribing practices. Good Clinical Practice. 2012;2;33-44 (In Russ.)