Patients with Atrial Fibrillation in Clinical Practice: Comorbidity, Drug Treatment and Outcomes (Data from RECVASA Registries)

Loukianov, М. М.; Andreenkо, E. Yu.; Martsevich, S. Yu.; Yakushin, S. S.; Vorobyev, A. N.; Переверзева, К. Г.; Zagrebelnyy, A. V.; Okshina, Е. Yu.; Yakusevich, V. V.; Pozdnyakova, Elena; Гомова, Т. А.; Fedotova, E. E.; Valiakhmetov, M. N.; Михин, В. П.; Maslennikova, Yu. V.; Klyashtorny, V. G.; Kudryashov, E. V.; Tatsii, Ju. E.; Boytsov, S. А.; Drapkina, О. М.

doi:10.20996/1819-6446-2020-12-01

Cited by 9 publications

(5 citation statements)

References 24 publications

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“…Ингибиторы 3-гидрокси-3-метилглютарил-коэнзим А (ГМГ-КоА) редуктазы (статины) рекомендуется назначать всем пациентам с ИБС 1 для профилактики сердечно-сосудистых осложнений [12]. В то же время в российских исследованиях реальной практики на основании данных регистров и анализа первичной медицинской документации было показано, что частота назначения данных групп лекарственных препаратов (ЛП) у пациентов с ИБС, ФП и ХСН недостаточна [7,10,[15][16][17].…”

Section: ключевые моменты что известно о предмете исследования?unclassified

“…Мы изучили в модели более затратный сценарий, предположив на основании анализа всех используемых регистров, что частота назначения ОАК составляет 33%, но при этом доля ПОАК была определена на основании двух наиболее современных регистров и составила порядка 90%. Такое предположение о доле ПОАК с нашей точки зрения соответствует современным российским клиническим рекомендациям, в которых рекомендовано назначение именно ПОАК у пациентов с неклапанной ФП 3 , ранее не получавших антикоагулянтную терапию [17]. Таким образом, вероятно, что в нашем исследовании была получена более высокая оценка затрат, которая может варьировать в зависимости от сложившейся ситуации на уровне различных регионов РФ.…”

Section: результатыunclassified

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Cost-effectiveness analysis of increasing drug therapy coverage for patients with coronary artery disease in combination with atrial fibrillation and heart failure

Ignatieva,

Kontsevaya,

Lukyanov

et al. 2024

Cardiovasc Ther Prev

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Aim. To make a cost-effectiveness analysis of increasing the prescription rate of combination therapy with beta-blockers (BBs), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs), statins and oral anticoagulants (OACs) in patients with coronary artery disease (CAD) in combination with atrial fibrillation (AF) and heart failure (HF).Material and methods. Based on the analysis of 6 medical registers, the proportion of patients with CAD in combination with AF and HF among all patients with CAD, and the prescription rate of BBs, ACEIs/ ARBs, OACs and statins, was assessed. Mortality and hospitalization rates were also determined in patients receiving only part of therapy or without it. In multivariate statistical models, the reduction in the risk of adverse events was calculated when all 4 drug groups were prescribed. Costs were calculated based on government procurement data and current compulsory health insurance rates. The obtained estimates were used to build a Markov model.Results. According to the modeling results, the number of patients with CAD in combination with AF and HF in the Russian Federation is 1,16-1,27 million people. When prescribing from 0 to 3 drug groups out of 4 required, the mortality rate was 115, and the hospitalization rate was 246 per 1000 patient-years. In the group of patients receiving all 4 groups of drugs, there was significant hazard ratio for death and hospitalization was 0,434 and 0,765, respectively. When modeling the prescription of drugs from all 4 groups in 1000 patients currently receiving only 0-3 groups of drugs, there was a reduction in the expected number of deaths by 52,3% (153 lives saved) and an expected number of hospitalizations by 16,0% (99 prevented hospitalizations) over 3 years. Additional costs per 1 life saved amounted to 515,3 RUB thousand.Conclusion. Patients with a combination of CAD, HF and AF are one of the groups with the highest risk of death and hospitalization for CVD. Modeling has shown that increasing coverage of this group of patients with appropriate therapy, including BBs, ACEIs/ARBs, statins and OACs, is a clinically and economically feasible solution.

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Section: ключевые моменты что известно о предмете исследования?unclassified

Section: результатыunclassified

Cost-effectiveness analysis of increasing drug therapy coverage for patients with coronary artery disease in combination with atrial fibrillation and heart failure

Ignatieva,

Kontsevaya,

Lukyanov

et al. 2024

Cardiovasc Ther Prev

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“…По данным многофакторного анализа, учитывавшего факторы возраста и пола, наличие ИБС, перенесенного ранее ИМ были ассоциированы с более высоким риском смерти (в 1,6 раза), а кроме того -с более высоким риском смерти (в 1,6 раза) и с более высоким риском развития комбинированной сердечно-сосудистой конечной точки (в 1,9 и в 1,7 раза). В анализируемой когорте пациентов с ФП, согласно опубликованным нами ранее данным, на долю смерти от сердечно-сосудистых причин приходилось 61,8% всех смертей [31].…”

Section: материал и методыunclassified

Combination of Atrial Fibrillation and Coronary Heart Disease in Patients in Clinical Practice: Comorbidities, Pharmacotherapy and Outcomes (Data from the REСVASA Registries)

Lukyanov¹,

Martsevich²,

Andrenko³

et al. 2021

Racionalʹnaâ farmakoterapiâ v kardiologii

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Aim. Assess the structure of comorbid conditions, cardiovascular pharmacotherapy and outcomes in patients with atrial fibrillation (AF) and concomitant coronary artery disease (CAD) included in the outpatient and hospital RECVASA registries.Materials and methods. 3169 patients with AF were enrolled in outpatient RECVASA (Ryazan), RECVASA AF-Yaroslavl registries and hospital RECVASA AF (Moscow, Kursk, Tula). 2497 (78.8%) registries of patients with AF had CAD and 703 (28.2%) of them had a previous myocardial infarction (MI).Results. There were 2,497 patients with a combination of AF and CAD (age was 72.2±9.9 years; 43.1% of men; CHA2DS2-VASc – 4.57±1.61 points; HAS-BLED – 1.60±0,75 points), and the group with AF without CAD included 672 patients (age was 66.0±12.3 years; 43.2% of men; CHA2DS2-VASc – 3.26±1.67 points; HAS-BLED – 1,11±0.74 points). Patients with CAD were on average 6.2 years older and had a higher risk of thromboembolic and hemorrhagic complications (p<0.05). 703 patients with a combination of AF and CAD had the previous myocardial infarction (MI; age was 72.3±9.5 years; 55.2% of men; CHA2DS2-VASc – 4.57±1.61; HAS-BLED – 1.65±0.76), and 1794 patients didn't have previous MI (age was 72.2±10.0 years; 38.4% of men; CHA2DS2-VASc – 4.30±1.50; HAS-BLED – 1.58±0.78). The proportion of men was 1.4 times higher among those with the previous MI. Patients with a combination of AF and CAD significantly more often (p <0.0001) than in the absence of CAD received a diagnosis of hypertension (93.8% and 78.6%), chronic heart failure (90.1% and 51.2%), diabetes mellitus (21.4% and 13.8%), chronic kidney disease (24.8% and 17.7%), as well as anemia (7.0% and 3.0%; p=0.001). Patients with and without the previous MI had the only significant difference in the form of a diabetes mellitus higher incidence having the previous MI (27% versus 19.2%, p=0.0008). The frequency of proper cardiovascular pharmacotherapy was insufficient, mainly in the presence of CAD (67.8%) than in its absence (74.5%), especially the prescription of anticoagulants (39.1% and 66.2%; p <0.0001), as well as in the presence of the previous MI (63.3%) than in its absence (74.3%). The presence of CAD and, in particular, the previous MI, was significantly associated with a higher risk of death (risk ratio [RR]=1.58; 95% confidence interval [CI] was 1.33-1.88; p <0.001 and RR=1.59; 95% CI was 1.33-1.90; p <0.001), as well as with a higher risk of developing a combined cardiovascular endpoint (RR=1.88; 95% CI was 1.17-3 , 00; p <0.001 and RR=1.75; 95% CI was 1.44-2.12; p<0.001, respectively).Conclusion. 78.8% of patients from AF registries in 5 regions of Russia were diagnosed with CAD, of which 28.2% had previously suffered myocardial infarction. Patients with a combination of AF and CAD more often than in the absence of CAD had hypertension, chronic heart failure, diabetes, chronic kidney disease and anemia. Patients with the previous MI had higher incidence of diabetes than those without the previous MI. The frequency of proper cardiovascular pharmacotherapy was insufficient, and to a greater extent in the presence of CAD and the previous MI than in their absence. All-cause mortality was recorded in patients with a combination of AF and CAD more often than in the absence of CAD. All-cause mortality and the incidence of nonfatal myocardial infarction were higher in patients with AF and the previous MI than in those without the previous MI. The presence of CAD and, in particular, the previous MI, was significantly associated with a higher risk of death, as well as a higher risk of developing a combined cardiovascular endpoint.

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“…По данным 5 амбулаторно-поликлинических регистров РЕКВАЗА из 3169 пациентов с ФП у 2497 (78,8%) имела место ИБС, а предшествующий ИМ был у 703 (22,2%) пациентов [18]. В многоцентровом регистре РИФ-ХСН, в который было включено 1003 пациента с ФП и хронической сердечной недостаточностью (СН), сопутствующая ИБС была у 686 (68,4%), а предшествующий ИМ -у 382 (38,1%) больных [19].…”

Section: распространенность ибс и ее влияние на исходы у пациентов с фпunclassified

“…В РКИ AFFIRM наличие ИБС уменьшало выживаемость пациентов с ФП на 55% [20]. По данным регистра РЕКВАЗА у пациентов с ФП предшествующий ИМ увеличивал риск сердечно-сосудистой смерти на 52% (р=0,001), смерти от всех причин на 39% (р=0,001) [18]. Наличие ИБС у пациентов с ранее диагностированной ФП ассоциировано с рецидивирующими эпизодами ФП [21], симптомной СН [22] и повышенной смертностью [23].…”

Section: распространенность ибс и ее влияние на исходы у пациентов с фпunclassified

Practical aspects of antithrombotic therapy in patients with atrial fibrillation and coronary artery disease

Кобалава

Shavarov

2021

Russ J Cardiol

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Atrial fibrillation (AF) is the most common cardiac arrhythmia, which is associated with an increased risk of cardiovascular death. The latter is partly due to the common combination with coronary artery disease (CAD). If indicated, patients with AF need continuous direct oral anticoagulant therapy to prevent thromboembolic events. In addition, patients with CAD who require urgent or elective percutaneous coronary intervention require dual antiplatelet therapy. Therefore, physicians often face a dilemma when choosing the most appropriate antithrombotic therapy regimen for AF patients undergoing percutaneous coronary intervention. Integrating two medication approaches to treat a single patient with a combination of AF and CAD is challenging and must strike a balance between high efficacy and safety. This article provides an overview of studies on this issue.

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Patients with Atrial Fibrillation in Clinical Practice: Comorbidity, Drug Treatment and Outcomes (Data from RECVASA Registries)

Cited by 9 publications

References 24 publications

Cost-effectiveness analysis of increasing drug therapy coverage for patients with coronary artery disease in combination with atrial fibrillation and heart failure

Cost-effectiveness analysis of increasing drug therapy coverage for patients with coronary artery disease in combination with atrial fibrillation and heart failure

Combination of Atrial Fibrillation and Coronary Heart Disease in Patients in Clinical Practice: Comorbidities, Pharmacotherapy and Outcomes (Data from the REСVASA Registries)

Practical aspects of antithrombotic therapy in patients with atrial fibrillation and coronary artery disease

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