Medical compliance to evidence-based clinical guidelines on secondary prevention of coronary heart disease in a hospital from Lima, Peru: a retrospective study

Castañeda-Amado, Zaira; Calixto-Aguilar, Lesly; Munárriz, César Loza; Palomino, Félix A. Medina

doi:10.5867/medwave.2017.05.6989

Cited by 3 publications

(2 citation statements)

References 7 publications

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“…Низкая приверженность такой терапии приводит не только к снижению ее эффективности, но и к развитию повторных осложнений [4,5]. Отсутствие приверженности лечению служит частой причиной неблагоприятных исходов [6]. Метаанализ 44 исследований, охвативший почти 2 млн больных с сердечно-сосудистыми заболеваниями (ССЗ), показал, что высокая приверженность терапии (>80%) встречается в 60% случаев и сопровождается снижением риска смерти от ССЗ на 20%, а смерти от любых причин -на 35%, в то время как низкая приверженность служит причиной не менее 13 смертей от ССЗ на 100 тыс.…”

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Use of combination pills with acetylsalicylic acid and clopidogrel in coronary artery disease. Efficacy and assessment of adherence to treatment: Kobra Study

Lomakin¹,

Buryachkovskaya²,

Senichkina³

et al. 2021

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Aim. Assessment of the efficacy and adherence to treatment with acetylsalicylic acid (ASA) and clopidogrel combination drug compared to separate administration of the drugs in patients with acute coronary syndrome and patients with chronic coronary syndrome after coronary stent implantation. Materials and methods. The study included 100 patients randomized to receive either original clopidogrel (Plavix® Sanofi) only or original ASA (Aspirin® Cardio Bayer) only or the generic fixed drug combination (Plagril® A Dr. Reddy's Laboratories Ltd.). Over the first 7–10 days after the index event, all patients were treated with a separate drug in the hospital, then received double antiplatelet therapy with appropriate drugs on an outpatient basis for 4 months, and purchased the drugs on their own for the last 2 months of follow-up. Monitoring the efficacy of therapy and patient adherence to treatment was carried out according to the clinic data, platelet aggregation indicators and blood thromboxane B2 (TXB2), salicylic acid and clopidogrel metabolite (carboxylic acid) levels on the 7th day after disease onset and after 8 and 16 weeks of treatment. Results. Most of the patients were elderly (mean age 68.3±10.6 years), of them 35% were women. After 8 and 16 weeks of treatment in hospital, platelet aggregation indicators did not differ between patients taking separate drugs or a fixed combination. The generic Plagril® A inhibited the aggregation response similarly to the original drugs. At moment of randomization, baseline blood TXB2, salicylic acid and the carboxyl metabolite of clopidogrel levels were comparable in both groups of patients (p>0.05). After 8 weeks of therapy, patients taking Plagril® A had significantly lower TXB2 levels compared with the separate administration of Plavix and Aspirin Cardio: 0.1±0.05 ng/ml vs 0.2±0.23 ng/ml, respectively (p<0.001). After 16 weeks, TXB2 levels reached 0.28±0.56 ng/ml vs 0.43±0.48 ng/ml, respectively (p=0.006). There were no differences in blood salicylic acid and clopidogrel carboxyl metabolite blood levels between the groups of patients during the entire study period. Adherence to antiplatelet therapy during inpatient period of treatment was 100%. In the first 8 weeks, it decreased to 74.5%, and after 16 weeks – to 71.5%. When taking the drugs separately, missing rate was higher in ASA group: 21.2% vs 5% in clopidogrel group. Conclusion. Plagril® A is bioequivalent and as effective as the original ASA and clopidogrel taken separately, in terms of the effect on platelet activity and blood clopidogrel metabolite levels. The adherence to a fixed combination of clopidogrel and ASA in patients with acute coronary syndrome and patients with chronic coronary syndrome is significantly higher than when these drugs are taken separately, both at the stages of free treatment and when purchasing drugs on their own. Keywords: antiplatelet therapy, acetylsalicylic acid, clopidogrel, adherence to secondary prevention, coronary heart disease For citation: Lomakin NV, Buryachkovskaya LI, Senichkina AA, Sumarokov AB, Docenko UV, Kazey VI. Use of combination pills with acetylsalicylic acid and clopidogrel in coronary artery disease. Efficacy and assessment of adherence to treatment: Kobra Study. Consilium Medicum. 2021; 23 (1): 61–69. DOI: 10.26442/20751753.2021.1.200780

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Section: Introductionunclassified

Use of combination pills with acetylsalicylic acid and clopidogrel in coronary artery disease. Efficacy and assessment of adherence to treatment: Kobra Study

Lomakin¹,

Buryachkovskaya²,

Senichkina³

et al. 2021

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show abstract

“…The use of evidence-based medications such as antiplatelets, statins, β-blockers, and angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) has been reported to reduce the risk of recurrent nonfatal and fatal disease in patients with CHD (Hamm et al, 2011; Smith et al, 2011). However, when patients with CHD leave the hospital and return to the community, they may have poor medication adherence, which can increase the likelihood of cardiovascular events and mortality (Ho et al, 2006; Gehi et al, 2007; Chowdhury et al, 2013; Castaneda-Amado et al, 2017). Therefore, it is crucial that more efforts should be made to improve medication adherence to improve the prognosis of CHD.…”

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confidence: 99%

Impacts of Clinical Pharmacist Intervention on the Secondary Prevention of Coronary Heart Disease: A Randomized Controlled Clinical Study

Zhang

Yang

et al. 2019

Front. Pharmacol.

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Coronary heart disease (CHD) is one of the leading causes of morbidity and mortality worldwide, and more efforts should be made to reduce the risk of cardiovascular events. This study aimed to investigate the impact of clinical pharmacist intervention on the prognosis of acute coronary syndrome (ACS) in Chinese patients with CHD. Two hundred and forty patients who had ACS were recruited. Participants were randomly assigned to the intervention group (n = 120) or the control group (n = 120). The intervention group received a medication assessment and education by the clinical pharmacist at discharge and telephone follow-ups at 1 week and 1 and 3 months after discharge. The control group received usual care. The primary outcomes of this study were the proportion of patients who had major adverse cardiovascular events (MACEs), including mortality, nonfatal myocardial infarction (MI), stroke, and unplanned cardiac-related rehospitalizations within 6 and 12 months after hospital discharge. Secondary outcome was self-reported medication adherence to evidence-based medications for CHD (antiplatelets, statins, β-blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers). Of 240 enrolled patients, 238 (98.3%) completed 6-month follow-up, and 235 (97.9%) completed 12-month follow-up. There were no significant differences between intervention and control groups in the percentages of patients who incurred MACEs within the 6-month follow-up (3.3% vs 7.6%, respectively, P = 0.145) or 12-month follow-up (10.9% vs 12.1%, respectively, P = 0.783). Significant improvements were found in the prescribing rates of β-blockers and all four classes of medications at discharge in the intervention group compared with the control group (P = 0.001 and P = 0.009, respectively). There was no significant difference between the intervention and control groups in the use of all four classes of medications at the 6-month follow-up (48.3% vs 45.8%, respectively, P = 0.691) and 12-month follow-up (47.9% vs 46.6%, respectively, P = 0.836). The use of β-blockers was nonsignificantly higher in the intervention group than in the control group at the 6-month follow-up (74.2% vs. 64.4%, P = 0.103) and 12-month follow-up (74.8% vs 63.8%, P = 0.068). Clinical pharmacist intervention had no significant effects on reduction in cardiovascular events among patients with CHD. Further studies with larger sample sizes and longer time frames for both intervention and follow-up are needed to validate the role of the clinical pharmacist in the morbidity and mortality of CHD. Clinical Trial Registration: , identifier ChiCTR-IOR-16007716.

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Are we ready for conformance checking in healthcare? Measuring adherence to clinical guidelines: A scoping systematic literature review

Oliart

Rojas

Capurro

2022

Journal of Biomedical Informatics

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Medical compliance to evidence-based clinical guidelines on secondary prevention of coronary heart disease in a hospital from Lima, Peru: a retrospective study

Abstract: Medical compliance to guidelines recommendations in secondary cardiovascular prevention is suboptimal with a compliance score under 50%.

Cited by 3 publications

References 7 publications

Use of combination pills with acetylsalicylic acid and clopidogrel in coronary artery disease. Efficacy and assessment of adherence to treatment: Kobra Study

Use of combination pills with acetylsalicylic acid and clopidogrel in coronary artery disease. Efficacy and assessment of adherence to treatment: Kobra Study

Impacts of Clinical Pharmacist Intervention on the Secondary Prevention of Coronary Heart Disease: A Randomized Controlled Clinical Study

Are we ready for conformance checking in healthcare? Measuring adherence to clinical guidelines: A scoping systematic literature review

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