The aim: To carry out an evaluation of comorbidities in CCS patients having undergone PCI for stable coronary artery diseases (planned) or PCI in myocardial infarction (urgent) with the aim of justifying the best management strategies. Materials and methods: We carried out an analysis of comorbid pathology spreading and the evaluation of multiple comorbidities using of Combined Age Charlson Comorbidity Index (CA-CCI) – in 138 patients below 75 yrs having undergone urgent and planned PCI. These patients were divided into two groups; the Ist one included 60 patients with urgent PCI (angioplasty with stent), the 2nd group – 78 patients with planned PCI. Results: We found a high prevalence of comorbidity in CCS patients: the mean number of diseases in patients of the 1st and 2nd groups were 8.2±0.3 and 9.3±0.4, and the CACCI values – 7.3±0.3 and 7.5±0.2, respectively (p>0.05). Ten and more diseases were found in (28.3±5.8%) patients from the 1st group and in (43.6±5.6%) patients from the 2nd group (p=0.06). The most frequent comorbidities were arterial hypertension, cerebrovascular diseases, peripheral arterial disease, type 2 diabetes mellitus, and impaired glucose metabolism. Conclusions: Comprehensive assessment and management of patients with CCS who undergo PCI remains a current problem in modern medicine, given the high prevalence of comorbid pathology.
Current approaches to medical care optimization for patients with multimorbidity. Diachuk D.D., Hidzynska I.M., Moroz G.Z., Tkachuk I.M. Scientific interest to the problem of multimorbidity is increasing due to the increase of the number of such patients. The aim of this work was to analyze and summarize current approaches to optimizing care for patients with multimorbidity and the results of their implementation in clinical practice. Since the beginning of this century, a number of documents have been created by WHO, government agencies and professional medical societies to improve medical care to patients with multimorbidity. The evidential basis of the effectiveness of the majority of the proposed measures based primarily on expert consensus. In 2016 NICE has published a clinical guideline NG56 «Multimorbidity: clinical assessment and management», WHO -a monograph «Multimorbidity: Technical Series on Safer Primary Care». In 2017 NICE has published a quality standard -Quality Standard №153 «Multimorbidity». The strategy of improvement of medical care for patients with multimorbidity is directly related to the patient-centered approach formation, which includes comprehensive assessment of the patient's condition. The main component of medical care is the definition of a realistic goal of medical intervention according to patient`s preferences, and making the choice of the optimal amount of diagnostic, treatment, and preventive measures, which can lead to the desired goal. A number of studies (the 3D randomized controlled trial, the MultiCare AGENDA, the SPPiRE study, the WestGem study etc.) have being conducted to evaluate the effectiveness of implementing proposed approaches in clinical practice. The results of the studies and meta-analysis do not provide conclusive evidence of the medical and economic effectiveness of their implementation at the presentstage. Improving the outcomes of medical care to patients with multimorbidity involves conducting further clinical trials that can provide evidence to determine the list of most effective interventions for clinical practice. Реферат. Сучасні підходи до оптимізації медичної допомоги пацієнтам з мультиморбідністю. Дячук Д.Д., Гідзинська І.М., Мороз Г.З., Ткачук І.М. Науковий інтерес до проблеми мультиморбідності зростає через збільшення кількості таких пацієнтів. Метою цього дослідження було проведення аналізу й узагальнення сучасних підходів до оптимізації медичної допомоги хворим з мультиморбідністю та результатів їх впровадження у клінічну практику. З початку цього століття ВООЗ, державні установи та професійні медичні товариства створили ряд документів для вдосконалення медичної допомоги пацієнтам з мультиморбідністю. Доказова база ефективності більшості запропонованих заходів в основному ґрунтується на консенсусі експертів. У 2016 році NICE опублікував клінічні настанови NG56 «Мультиморбідність: клінічна оцінка та управління», ВООЗ -монографію «Мультиморбідність: Технічна серія щодо безпечної первинної допомоги». У 2017 році NICE опублікував стандарт якості -...
Objective: to evaluate current approaches to the training of physicians on comorbidity and multimorbidity and to develop and implement a training module “Comorbidity in patients with coronary artery disease: current approaches to treatment” in the Training Center "Institute of Postgraduate Education" of the State Institution of Sciences “Research and Practical Center of Preventive and Clinical Medicine” State Administrative Department (SIS “RPC PCM” SAD). Material and methods. We carried out an analysis and generalization of recent publications on the topic of the management challenges in patients with coronary artery disease and comorbidities and review the literature focusing on postgraduate training of medical doctors in the area of multimorbidity After the implementation of the training module we made a survey of 60 physicians on their assessment of the information provided. Results and discussion: Current scientific research substantiates the feasibility of introducing both face-to-face trainings and master classes, as well as distance learning to optimize the training programmes for doctors in managing patients with multimorbidity and comorbidity. We developed and implemented a training module “Comorbidity in patients with coronary artery disease: current approaches to treatment” in the Training Center "Institute of Postgraduate Education" of SIS “RPC PCM” SAD. We identified major theoretical issues and practical skills that should be acquired by the physician, we worked out the methodology for presenting information during full-time and distance learning. The educational process includes lectures (including the use of distance learning), and a workshop format and master classes with the analysis of specific clinical cases. Conclusions: 97.1% of respondents rated positively the implementation of continuing medical education on the topic of coronary artery disease management in patients with comorbidities with the use of distance learning and the appliance of master classes with the analysis of clinical cases. Optimal educational format is a significant issue which needs further research. Any training on the management of multimorbidity in practice must be outcome-oriented, in order to change practice and improve clinical outcomes for complex patients.
Purpose: To evaluate the achievement of target blood pressure (BP) level in patients with coronary heart disease and hypertension who were under follow-up of cardiologists of the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department Materials and methods: We evaluated 1120 electronic medical records (medical software program “ESCUL’ap”) and carried out an analysis of target BP level’s achievement in 512 patients with coronary heart disease and hypertension who were under follow-up of cardiologists of the Therapeutic department of our institution and were reviewed by a cardiologist in 2019. The percentage of female patients was 30,1±2,0%. Patient`s age ranged from 37 to 91 years, the mean age was 72,1±0,4 years, 72,8±0,6 years in woman and 71,8±0,4 years in mans. We used statistical software programs (Statistica v. 6.0) and Microsoft Excel 2007 applications for data analysis. Categorical data were presented as absolute and relative (%) frequency. To enable comparisons, we calculated the mean value (M), and the the standard error of the mean (m). Student's t-test was used to compare the mean of data for groups. Results and discussion: According to data of the medical records the target level of BP (<140/90 mm Hg) was attained in 343 of 512 patients (67,0±2,1%) – in 70,1±2,4% of male patients and 59,7±4,0% of women (р>0,05). The highest rate of target BP achievement – 83,3±6,8% – was in 50-59 years old, the lowest – 61,5±3,2% – in 70-79 years old. Our results were significantly better than in the EUROASPIRE IV survey – according to the results of this study the target BP levels were achieved only by 38% of men and 47% of women in Ukraine and by 35% of men and 48% of women in other European countries. Conclusions. Our study demonstrates that 67,0±2,1% (70,1±2,4% of mans and 59,7±4,0% of women) of patients with coronary heart disease and hypertension who were under follow-up of cardiologists achieved the target level of BP (<140/90 mm Hg). These data confirms the effectiveness of the model of medical care for patients with hypertension, introduced in the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department
Aim: to evaluate current approaches to the assessment of comorbidity in clinical practice and determine the prevalence of comorbidities in patients with coronary artery disease (CAD) who underwent coronary artery stenting. Material and methods. We performed a retrospective analysis of data from electronic medical records of 150 CAD patients below 75 yrs having undergone myocardial revascularization via percutaneous coronary intervention (coronary artery stenting). All of them were under the monitoring of the cardiologists of the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine” State Administrative Department. Comorbidity assessment was performed via diseases count; we have dealt only with diseases that are included in the Charlson Comorbidity Index (ССІ) and Combined Age Charlson Comorbidity Index (СА-ССІ) calculation proceeding. We used statistical software programs (Statistica v. 6.0) and Microsoft Excel 2007 applications for data analysis. Results. According to data of the medical records the most common comorbidities (among those used to calculate CCI and CA-CCI) in patients with CAD below 75 yrs who underwent coronary artery stenting were cerebrovascular disease (83.3 ± 3.0%), peripheral vascular diseases (42,7±4,0%), type 2 diabetes mellitus, and mild liver diseases (24,0±3,6%). It was found that the number of comorbid diseases in patients having been examined ranged from 2 to 7, with an average of 3,9±0,1. The mean number of diseases in patients of different ages did not differ significantly. The average CA-CCI value increased from 4,4±0,2 points in patients who had two diseases to 12,7±1,1 points in those with seven ones (р<0,05). Conclusions. Our study revealed a high prevalence of comorbidities in patients with CAD below 75 yrs who underwent coronary artery stenting. The use of CA-CCI allowed making a comprehensive assessment of patient’s conditions
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