Assessment of the Quality of Drug Therapy in Patients with Stable Coronary Artery Disease in the Second Stage of the ALIGN Study

Aim. To assess adjusted pharmacotherapy for prescribing drugs of the main classes, according to clinical guidelines, and achieving target levels of lowdensity lipoprotein cholesterol (LDL-C) in patients with stable coronary heart disease (CHD).

Material and methods. Of the 73 patients included in the ALIGN study, 64 patients (53 males and 11 females; mean age 68,2±9,4 years) with stable coronary artery disease attended a second visit (3 months after the initial treatment adjustment). Prescribed drug therapy, its compliance with clinical guidelines, achievement of lipid profile and blood pressure (BP) targets were studied in all patients.

Results. An increase in the frequency of taking beta-blockers (p=0.002), lipid-lowering drugs (p=0.008) by patients was found during the second visit. The proportion of patients taking all 4 groups of drugs according to clinical guidelines (statins, antiplatelet agents, beta-blockers, angiotensinconverting enzyme inhibitors / angiotensin II receptor blockers) increased from 44% to 65.5% (p<0.001) after correction of therapy, as well as an increase in the proportion of patients taking 1 antianginal drug in the presence of exertional angina from 75% to 89% (p<0.001) was found. About 90% of hypertensive patients achieved the target level of systolic blood pressure (p<0.001). Achievement of the target level of cholesterol low density lipoprotein (<1.8 mmol/l) during the second visit was found in half of the patients (p=0.004).

Conclusion. Despite the initial correction of drug therapy by the staff of the cardiology department, the prescribed treatment for patients with stable coronary artery disease did not in all cases comply with clinical guidelines due to insufficient adherence of doctors and insufficient adherence of patients to prescribed medical recommendations.

Working group of the register PROFILE: Voronina V. P., Dmitrieva N. A., Komkova N. A., Zagrebelny A.V., Kutishenko N.P., Lerman O.V., Lukina Yu. V., Tolpygina S.N., Martsevich S.Yu.

1. Surinov AE, Baranov EF, Bezborodova TS, et al. Russian Statistical Yearbook [cited 2022 Feb 20]. Available from: https://gks.ru/bgd/regl/b18_13/Main.htm (In Russ.)

2. Members Task Force Members; Montalescot G., Sechtem U., Achenbach S. et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003. DOI:10.1093/eurheartj/eht296.

3. Gislason GH, Rasmussen JN, Abildstrøm SZ, et al. Long-term compliance with beta-blockers, angiotensin-converting enzyme inhibitors, and statins after acute myocardial infarction. Eur Heart J. 2006;27(10):1153-58. DOI:10.1093/eurheartj/ehi705.

4. Birukova LA. Delications to the treatment of the patients with ishemic heart disease with pain and painless for of the disease. Siberian Medical Journal. 2008;79(4):75-7 (In Russ.)

5. Oganov RG, Lepakhin VK, Fitilev SB, et al. Stable angina pectoris: population trends, diagnostics, secondary prevention, and antianginal therapy. Cardiovascular Therapy and Prevention. 2006;5(1):4954 (In Russ.)

6. Granger BB, Swedberg K, Ekman I, et al. Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial. Lancet. 2005;366(9502):2005-11. DOI:10.1016/S0140-6736(05)67760-4.

7. Martsevich SYu, Zharkova ED, Kutishenko NP, et al. An Attempt to Accord the Quality of Therapy of Stable Coronary Heart Disease Patients with Current Clinical Guidelines (ALIGN study): Design and the First Results. Rational Pharmacotherapy in Cardiology. 2020;16(1):75-81 (In Russ.) DOI:10.20996/1819-6446-2020-02-08.

8. Desai NR, Wade RL, Xiang P, et al. Low‐density lipoprotein cholesterol lowering in real‐world patients treated with evolocumab, Clin Cardiol. 2021;44(5):715-22. DOI:10.1002/clc.23600.

9. Motivala AA, Parikh V, Roe M, et al. Predictors, Trends, and Outcomes (Among Older Patients ≥65 Years of Age) Associated With Beta-Blocker Use in Patients With Stable Angina Undergoing Elective Percutaneous Coronary Intervention: Insights From the NCDR Registry. JACC Cardiovasc Interv. 2016;9(16):1639-48. DOI:10.1016/j.jcin.2016.05.048.

10. Chazova IE, Zhernakova YuV, on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019;16(1):6-31 (In Russ.) DOI:10.26442/2075082X.2019.1.190179.

11. Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016;37(39):2999-3058. DOI:10.1093/eurheartj/ehw272.

12. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889-934. DOI:10.1016/j.jacc.2013.11.002.

13. Andres E, Bleek J, Stock J, et al. Qualitätsindikatoren zur Koronaren Herzkrankheit im Praxistest Measuring, assessing, acting: A practice test of quality indicators for coronary heart disease [Measuring, assessing, acting: A practice test of quality indicators for coronary heart disease]. Z Evid Fortbild Qual Gesundhwes. 2018;137-138:9-19 (In German). DOI:10.1016/j.zefq.2018.08.003.

14. Ageenkova OA. Analysis of adherence to therapy at the post-hospital stage in patients with arterial hypertension and ishemic heart disease. Smolensk Medical Almanac. 2019;(3):11-9 (In Russ.)

15. Ergatoudes C, Thunström E, Rosengren A, et al. Long-term secondary prevention of acute myocardial infarction (SEPAT) - guidelines adherence and outcome. BMC Cardiovasc Disord. 2016;16(1):226. DOI:10.1186/s12872-016-0400-6.

16. Farkouh M., Boden W., Bittner V. et al. Risk factor control for coronary artery disease secondary prevention in large randomized trials. J Am Coll Cardiol. 2013; 61(15): 1607-15. doi: 10.1016/j.jacc. 2013.01.044

17. Tolpygina SN, Polyanskaya YN, Martsevich SYu. Treatment of patients with chronic ischemic heart disease in real clinical practice according to the data from PROGNOZ IBS register (Part 1). Rational Pharmacotherapy in Cardiology. 2013;9(2):138-42 (In Russ.) DOI:10.20996/1819-6446-2013-9-2-138142.

18. Vasyuk YA, Shalnova SA, Shkolnik EL, Kulikov KG. The PRIMA study: trimetazidine modified release of the active ingredient in the treatment of patients with stable angina pectoris, myocardial infarction. Epidemiological and clinical stages. Kardiologiia. 2008;48(12):1-4 (In Russ.)

19. Shalnova SA, Oganov RG, Stag FG, Ford I. on behalf of the register CLARIFY. Coronary Heart Disease. Modern reality according to the World Register CLARIFY. Kardiologiia. 2013;53(8):28-33 (In Russ.)

20. Kotseva K, Wood D, De Backer G, et al., EUROASPIRE Study Group. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil. 2009;16(2):121-37. DOI:10.1097/HJR.0b013e3283294b1d.