Aim. To study doctors’ knowledge of the clinical guidelines on the use of oral anticoagulants and identify the reasons for poor adherence.Material and methods. The results of the 218 questionnaires completed by the doctors trained in the 2018-2019 were analyzed. The questionnaire included 12 items regarding the main aspects of oral anticoagulants use. 71.6% of respondents were cardiologists, 18.8% were therapists (including general practitioners) and 9.6% were representatives of other specialties.Results. The obtained data show that therapists are worse than cardiologists aware of indications for oral anticoagulants in atrial fibrillation, and do not always correctly assess the risk of thromboembolism. Only 24.4% of therapists consider prescribing rivaroxaban in a dose of 2.5 mg 2 times a day to a patient suffering from myocardial infarction with an ST segment elevation on the electrocardiogram. One third of therapists either do not know or do not support current recommendations regarding oral anticoagulants use in paroxysmal atrial fibrillation. 65.3% cardiologists are inclined to start anticoagulant therapy only in patients at high risk for thromboembolism, while 36.6% therapists are ready to start such treatment even at moderate risk. Respondents' answers to the questionnaire demonstrate their great alertness regarding possible bleeding. Overestimation of the bleeding risk is more often among therapists than cardiologists (44.9% and 17.1%, respectively). More than one third of therapists (36.6%) are ready to recommend a reduced dose of oral anticoagulant to patients without clear reasons. Fear of bleeding has a greater influence on the decision to prescribe an anticoagulant and the choice of treatment regimen for atrial fibrillation than the desire to effectively prevent thromboembolism.Conclusion. The results of the survey show that the doctors’ adherence to the clinical guidelines’ basic principles of the use of oral anticoagulants among cardiologists is higher than that of therapists. Wherein, even among cardiologists it cannot be considered sufficient. The lack of doctors’ awareness about the identification, assessment, and modification of risk factors for bleeding was revealed.
Aim To evaluate the physician’s knowledge of basic provisions of clinical guidelines for diagnosis and treatment of chronic heart failure (CHF) and to determine how the actions of physicians in their everyday clinical practice comply with these provisions.Materials and methods The study analyzed anonymous questionnaires of 185 physicians (127 cardiologists, 40 internists and general practitioners, 18 other specialists) who were trained in advanced training programs during the 2020/2021 academic year. The main part of the questionnaire included 15 questions related to the classification, diagnosis, pharmacotherapy, and the use of implantable devices in the treatment of patients with CHF.Results The results showed that internists were less than cardiologists aware of major provisions of clinical guidelines for diagnosis and treatment of CHF. However, the knowledge of cardiologists could not be considered sufficient either. 57.5% of internists and 30% of cardiologists incorrectly indicated the main echocardiographic criterion for diagnosis of CHF with reduced left ventricular ejection fraction (CHFrEF). More than 40% of internists did not consider fluid retention with development of the congestion syndrome as a mandatory condition for administration of a loop diuretic to a patient with CHFrEF. 34.6% of cardiologists and 25% of internists correctly determined the indication for the administration of mineralocorticoid receptor antagonists. 37.6% of internists and 21.1% of cardiologists incorrectly indicated the dose of spironolactone recommended for achieving the neuromodulation effect. In determining doses of angiotensin-converting enzyme (ACE) inhibitors and beta-blockers, after arriving at which it is necessary to stop their up-titration, most of the physicians preferred to be based on systolic blood pressure (SBP) rather than on symptoms of hypotension. However, among therapists there were doctors for whom the patient's well-being and clinical symptoms, and not the level of SBP, were priority factors for choosing the tactics of the treatment with ACE inhibitors and beta-blockers. Physicians of both specialties were poorly familiar with indications for cardioverter defibrillator implantation; only 14.2% of cardiologists and 5% of internists chose the correct wording of indications.Conclusion The insufficient knowledge should be considered the basis for the low adherence of doctors to guidelines for diagnosis and treatment of CHF. When developing programs for advanced training of physicians in CHF, special attention should be paid to the use of renin-angiotensin-aldosterone system inhibitors and beta-blockers with detailed discussion of the dosing principles as well as of indications for implantation and results of using cardioverter defibrillators.
The review is devoted to the clinical efficacy of sodium-glucose cotransporter type 2 (SGLT2) inhibitors. Information on the mechanisms of drug action is given, as well as rationale for their use in the management of patients with diabetes and heart failure (HF) is provided. The results of large-scale randomized clinical trials evaluating the efficacy of SGLT2 inhibitors are discussed. We showed the beneficial effect of SGLT-2 inhibitors on the risk of cardiovascular events in patients with type 2 diabetes. In addition, an evidence of the ability of dapagliflozin and empagliflozin to improve the prognosis of patients with HF with reduced ejection fraction without diabetes are presented. The evidence and mechanisms of the nephroprotective action of SGLT2 inhibitors in patients with diabetes and HF are considered.
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