Pharmacoepidemiological analysis of routine management of heart failure patients in the Russian Federation. Part I

Abstract

Aim. To assess the healthcare system costs for the management of patients with heart failure (HF) based on a retrospective analysis of primary medical documentation.Material and methods. We performed the analysis of outpatient records of 1000 patients, followed up for 1 year by a general practitioner or cardiologist in ambulatory clinic in 7 Russian regions. The study included men and women over 18 years of age with an established class II-IV HF and at least one hospitalization due to acute decompensated HF within 12-month follow-up.Results. The final analysis included 888 patients (men, 52,9%; women, 47,1%; mean age, 69 [61; 78] years). The preserved ejection fraction (EF) was detected in 47,86% of patients, mid-range — in 40,54%, reduced — in 11,6%. Only in 16% of patients, there was improved by 1 or more HF. Hypertension and coronary artery disease were predominant in etiology pattern of HF. Preserved EF was more often detected in women over 60 years of age, with HTN and obesity, as well as with HF with mid-range and reduced EF in men in the same age group. There was sufficient follow-up rate, but the extent examinations do not correspond to the recommended one. The prescription rate of renin-angiotensin-aldosterone system (RAAS) inhibitors corresponds to the recommended one, but there is a high frequency of prescribing angiotensin II receptor blockers (ARBs). The prescription rate of β-blockers and loop diuretics (mainly torasemide) increased in comparison with previous studies, while thiazide diuretics — decreased. In patients with reduced EF, the prescription rate of sacubitril/valsartan was only 14,7%, β-blockers — 83,3%, mineralocorticoid receptor antagonists (MCRA) — 72,5%. In patients with midrange EF, there was a sharp decrease in prescription rate of RAAS inhibitors, β-blockers, MCRA.Conclusion. The practical follow-up of patients with HF differs significantly from clinical guidelines. Due to inadequate pharmacotherapy, as well as insufficient noncompliance with the recommended extent of investigations, 1-year HF therapy does not lead to a pronounced improvement in the patients' class.