OUTPATIENT REGISTER OF CARDIOVASCULAR DISEASES IN THE RYAZAN REGION (RECVASA): PRINCIPAL TASKS, EXPERIENCE OF DEVELOPMENT AND FIRST RESULTS
https://doi.org/10.20996/1819-6446-2013-9-1-4-14
Abstract
Aim. To estimate risk factors and comorbidity structure, cardiovascular diseases outcomes, evaluate their diagnostics and treatment quality in real outpatient practice using a register of patients with arterial hypertension (HT), ischemic heart disease (IHD), chronic heart failure (CHF) and atrial fibrillation (AF) in the Ryazan Region – the territorial subject ofRussian Federation with high cardiovascular mortality rate.
Material and methods. The total of 1000 HT, IHD, CHF, AF patients, applied for general practitioners or cardiologists of theRyazan outpatient clinics in March-May of 2012 were sequentially enrolled in the outpatient REgister of CardioVAscular diseases (RECVASA).
Results. According to outpatient cards data HT, IHD, CHF and AF were diagnosed in 99.0%; 70.9%; 74.8% and 13.7% of the 1000 cases, respectively. 820 (82%) patients revealed a concomitant cardiovascular pathology (cardiac comorbidity), at that the most frequent was combination of HT with IHD and CHF (50.4%). Diabetes mellitus was diagnosed in 209 (20.9%) patients. 770 (77%) patients were assessed on their total cholesterol level; smoking status and family history of heart diseases were estimated in 28 (2.8%) and 49 (4.9%) patients, respectively. Exercise tolerance test (stress-test) was carried out in 2% of the patients (including 2.8% of the IHD patients), 24-hour blood pressure (BP) and ECG monitoring – in 0.7% and 5.5%, respectively; echocardiography and ultrasound of brachiocephalic arteries (BCA) – in 25.6% and 8.6%, respectively; coronary angiography – in 1.6% (which includes 2.3% of the IHD patients). The following drug groups were prescribed most frequently: antiplatelet agents – in 60.4% of the cases (584 patients received acetylsalicylic acid and 20 – clopidogrel), ACE inhibitors – in 62.9%, β-blockers – in 43.9% of the patients. Target BP level was achieved in 245 of 956 cases (25.6%). 50.6% of IHD patients and 51.1% of hypercholesterolemic patients received statins.
Conclusion. The pilot stage of the RECVASA study revealed a high incidence rate of cardiac comorbidity (82%) in patients with hypertension, IHD, CHF and AF, insufficient estimation of cardiovascular risk factors, inadequate frequency of stress-tests, 24-hour BP and ECG monitoring, echocardiography, BCA sonography, coronary angiography use, as well as a scarce prescription of warfarin in AF and statins in hypercholesterolemic patients. Improvement of correspondence to national guidelines is the main reserve for enhancement of diagnostics and treatment quality in patients with HT, IHD, CHF, AF and hypercholesterolemia.
About the Authors
S. A. Boytsov
State Research Centre for Preventive Medicine, Moscow
Russian Federation
Sergey A. Boytsov – PhD, MD, Professor, Director, Head of Department of Clinical Cardiology and Molecular Genetics of of the State Research Centre for Preventive Medicine (SRCPM)
Russian Federation
Sergey A. Boytsov – PhD, MD, Professor, Director, Head of Department of Clinical Cardiology and Molecular Genetics of of the State Research Centre for Preventive Medicine (SRCPM)
S. S. Yakushin
Ryazan State Medical University named after academician I.P. Pavlov
Russian Federation
Sergey S. Yakushin – PhD, MD, Professor, Head of Chair of Hospital Therapy
Russian Federation
Sergey S. Yakushin – PhD, MD, Professor, Head of Chair of Hospital Therapy
S. Yu. Martsevich
State Research Centre for Preventive Medicine, Moscow
Russian Federation
Sergey Yu. Martsevich – PhD, MD, Professor, Head of Department of Preventive Pharmacotherapy
Russian Federation
Sergey Yu. Martsevich – PhD, MD, Professor, Head of Department of Preventive Pharmacotherapy
M. M. Lukyanov
State Research Centre for Preventive Medicine, Moscow
Russian Federation
Mikhail M. Loukianov – PhD, MD, Leading Researcher of Department of Clinical Cardiology and Molecular Genetics
Russian Federation
Mikhail M. Loukianov – PhD, MD, Leading Researcher of Department of Clinical Cardiology and Molecular Genetics
N. N. Nikulina
Ryazan State Medical University named after academician I.P. Pavlov
Russian Federation
Natalya N. Nikulina – PhD, MD, Associate Professor of Chair of Hospital Therapy
Russian Federation
Natalya N. Nikulina – PhD, MD, Associate Professor of Chair of Hospital Therapy
A. V. Zagrebelny
State Research Centre for Preventive Medicine, Moscow
Russian Federation
Alexander V. Zagrebelnyy – PhD, MD, Senior Researcher of Department of Preventive Pharmacotherapy
Russian Federation
Alexander V. Zagrebelnyy – PhD, MD, Senior Researcher of Department of Preventive Pharmacotherapy
A. N. Vorobyov
Ryazan State Medical University named after academician I.P. Pavlov
Russian Federation
Alexander N. Vorobyov – PhD, MD, Assistant of Chair of Hospital Therapy
Russian Federation
Alexander N. Vorobyov – PhD, MD, Assistant of Chair of Hospital Therapy
K. G. Pereverseva
Ryazan State Medical University named after academician I.P. Pavlov
Russian Federation
Kristina G. Pereverseva – MD, Resident Physician of Chair of Hospital Therapy
Russian Federation
Kristina G. Pereverseva – MD, Resident Physician of Chair of Hospital Therapy
E. A. Pravkina
Ryazan State Medical University named after academician I.P. Pavlov
Russian Federation
Ekaterina A. Pravkina – MD, Postgraduate Student of Chair of Hospital Therapy
Russian Federation
Ekaterina A. Pravkina – MD, Postgraduate Student of Chair of Hospital Therapy
A. D. Deev
State Research Centre for Preventive Medicine, Moscow
Russian Federation
Alexander D. Deev — PhD, Head of Laboratory of Biostatistics, Department of Preventive Pharmacotherapy
Russian Federation
Alexander D. Deev — PhD, Head of Laboratory of Biostatistics, Department of Preventive Pharmacotherapy
E. Yu. Andreenko
State Research Centre for Preventive Medicine, Moscow
Russian Federation
Elena Yu. Andreenko – PhD, MD, Researcher of Department of Clinical Cardiology and Molecular Genetics
Russian Federation
Elena Yu. Andreenko – PhD, MD, Researcher of Department of Clinical Cardiology and Molecular Genetics
A. I. Ershova
State Research Centre for Preventive Medicine, Moscow
Russian Federation
Alexandra I. Ershova – PhD, MD, Researcher of Laboratory of Molecular Genetics, Department of Clinical Cardiology and Molecular Genetics
Russian Federation
Alexandra I. Ershova – PhD, MD, Researcher of Laboratory of Molecular Genetics, Department of Clinical Cardiology and Molecular Genetics
A. N. Meshkov
State Research Centre for Preventive Medicine, Moscow
Russian Federation
Alexey N. Meshkov – PhD, MD, Head of olecular Genetics, Department of Clinical Cardiology and Molecular Genetics
Russian Federation
Alexey N. Meshkov – PhD, MD, Head of olecular Genetics, Department of Clinical Cardiology and Molecular Genetics
R. P. Myasnikov
State Research Centre for Preventive Medicine, Moscow
Russian Federation
Roman P. Myasnikov – PhD, MD, Researcher of Department of Clinical Cardiology and Molecular Genetics
Russian Federation
Roman P. Myasnikov – PhD, MD, Researcher of Department of Clinical Cardiology and Molecular Genetics
S. E. Serdyuk
State Research Centre for Preventive Medicine, Moscow
Russian Federation
Russian Federation
Svetlana E. Serdyuk – PhD, MD, Senior Researcher of Department of Clinical Cardiology and Molecular Genetics
М. S. Kharlap
State Research Centre for Preventive Medicine, Moscow
Russian Federation
Maria S. Kharlap – PhD, MD, Senior Researcher of Department of Clinical Cardiology and Molecular Genetics
Russian Federation
Maria S. Kharlap – PhD, MD, Senior Researcher of Department of Clinical Cardiology and Molecular Genetics
References
1. Go A. S., Mozaffarian D., Roger V.L., et al. Heart Disease and Stroke Statistics -2013 Update: A Report From the American Heart Association. Circulation 2013;127: e6–e245.
2. Lopez A.D. et al., eds., Global Burden of Disease and Risk Factors. Washington: Oxford University Press and World Bank; 2006.
3. National guidelines for the diagnosis and treatment of hypertension (fourth revision). Sistemnye Gipertenzii
4. ; (3): 5–26. Russian (Национальные рекомендации по диагностике и лечению артериальной гипертонии (четвертый пересмотр). Системные гипертензии 2010; (3): 5–26).
5. Shal'nova S.A., Kukushkin S.K., Manoshkina E.M., Timofeeva T.N. Hypertension and adherence to therapy. Vrach 2009; (12); 39–42. Russian (Шальнова С.А., Кукушкин С.К., Маношкина Е.М., Тимофеева Т.Н. Артериальная гипертензия и приверженность терапии. Врач 2009; (12); 39–42).
6. Shal'nova S.A., Deev A.D. Coronary heart disease in Russia: prevalence and treatment (according to clinical and epidemiological studies). Ter Arkhiv 2012; 83(1): 7–12. Russian (Шальнова С.А., Деев А.Д. Ишемическая болезнь сердца в России: распространенность и лечение (по данным клинико-эпидемиологических исследований). Тер Архив 2012; 83(1): 7–12).
7. Shal'nova S.A., Balanova Yu.A., Konstantinov V.V. et al. Hypertension: prevalence, awareness, acceptance and effectiveness of antihypertensive treatment in the population of the Russian Federation. Rossiyskiy Kardiologicheskiy Zhurnal 2006; (4): 45–50. Russian (Шальнова С.А., Баланова Ю.А., Константинов В.В. и др. Артериальная гипертония: распространенность, осведомленность, прием антигипертензивных препаратов и эффективность лечения среди населения Российской Федерации. Российский Кардиологический Журнал 2006; (4): 45–50).
8. Zyablov Yu. I., Okrugin S. A., Orlova S. D. Long-term trends in incidence, mortality and mortality from acute coronary catastrophes in the open population of Tomsk. The results of monitoring under the "register of acute myocardial infarction" (1984–1998). Kardiologiia 2001;(7):54–55. Russian (Зяблов Ю. И., Округин С. А., Орлова С. Д. Многолетние тренды заболеваемости, смертности и летальности от острых коронарных катастроф в открытой популяции Томска. Результаты наблюдения по программе ≪Регистр острого инфаркта миокарда≫ (1984–1998 гг.). Кардиология 2001;(7):54– 55).
9. Martsevich S.Yu., Ginzburg M.L., Kutishenko N.P., et al. The LIS study (Lubertsy mortality study of patients with acute myocardial infarction): a portrait of the patient. Kardiovaskulyarnaya Terapiya i Profilaktika 2011;10(6):89–93. Russian (Марцевич С.Ю., Гинзбург М.Л., Кутишенко Н.П., и др. Ис- следование ЛИС (Люберецкое исследование смертности больных, перенесших острый инфаркт миокарда): портрет заболевшего. Кардиоваскулярная Терапия и Профилактика 2011;10(6):89– 93).
10. Martsevich S.Yu., Ginzburg M.L., Kutishenko N.P., i dr. Lubertsy study on mortality in patients with acute myocardial infarction. The first results of the ≪LIS≫ study. Klinitsist 2011;(2):24–27. Russian (Марцевич С.Ю., Гинзбург М.Л., Кутишенко Н.П., и др. Люберецкое исследование по изучению смертности больных, перенесших острый инфаркт миокарда. Первые результаты исследования ≪ЛИС≫. Клиницист 2011;(2):24–27).
11. Martsevich S.Yu., Ginzburg M.L., Kutishenko N.P., Deev A.D. i dr. The LIS study (Lyubertsy study of mortality in patients with acute myocardial infarction). Evaluation of the pharmacotherapy. Part 1. Treatment of patients before myocardial infarction and its influence on hospital mortality rate. Rational Pharmacother Card 2012;8(5):681–684. Russian (Марцевич С.Ю., Гинзбург М.Л., Кутишенко Н.П., Деев А.Д. и др. Исследование ЛИС (Люберецкое исследование смертности больных, перенесших острый инфаркт миокарда). Оценка лекарственной терапии. Часть 1. Как лечатся больные перед инфарктом миокарда, и как это влияет на смертность в стационаре. РФК 2012;8(5):681– 684).
12. Ohman EM, Bhatt DL, Steg PG, Goto S et al. The REduction of Atherothrombosis for Continued Health (REACH) Registry: an international, prospective, observational investigation in subjects at risk for atherothrombotic events-study design. Am Heart J 2006;151(4):786.e1–10.
13. Tang EW, Wong CK, Herbison P. Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome. Am Heart J 2007; 153(1): 29–35.
14. Kakkar AK, Mueller I, Bassand JP et al. International longitudinal registry of patients with atrial fibrillation at risk of stroke: Global Anticoagulant Registryin the FIELD (GARFIELD). Am Heart J 2012;163(1):13–19.e1.
15. Oshchepkova E.V., Dovgalevskiy P.Ya., Gridnev V.I. Register hypertension. Ter Arkhiv 2007;79(1): 46– 48. Russian (Ощепкова Е.В., Довгалевский П.Я., Гриднев В.И. Регистр артериальной гипертонии. Терапевтический Архив 2007;79(1): 46–48).
16. Posnenkova O.M., Kiselev A.R., Gridnev V.I. et al. Control of blood pressure in patients with hypertension in primary care. Kardiovaskulyarnaya Terapiya i Profilaktika 2012; 11(3): 4–11. Russian (Посненкова О.М., Киселев А.Р., Гриднев В.И. и др. Контроль артериального давления у больных гипертонией в первичном звене здравоохранения. Анализ данных регистра артериальной гипертонии. Кардиоваскулярная Терапия и Профилактика 2012; 11(3): 4–11).
17. Boytsov S.A., Krivonos O.V., Oshchepkova E.V. et al. Evaluation of the measures aimed at reducing the death rate from cardiovascular disease in the regions included in the program in 2008, according to the monitoring of the Health Ministry and the Russian Register of ACS. Menedzher Zdravookhraneniya 2010;(5):19–29. Russian (Бойцов С.А., Кривонос О.В., Ощепкова Е.В. и др. Оценка эффективности реализации мероприятий, направленных на снижение смертности от сосудистых заболеваний в регионах, включенных в программу в 2008 году, по данным мониторинга Минздравсоцразвития России и Регистра ОКС. Менеджер Здравоохранения 2010;(5):19–29).
18. The WHO program "Register of acute myocardial infarction," 25-year epidemiological study of myocardial infarction in Russia (1977–2001). Russian (Гафаров В.В., Гафарова А.В., Благинина М.Ю. Программа ВОЗ ≪Регистр острого инфаркта миокарда≫: 25-летнее эпидемиологическое исследование инфаркта миокарда в России (1977–2001). Кардиология 2005; (8): 48–50).
19. Gafarov V.V., Gorokhova E.V., Gafarova A.V., Tatarinova V.V. Acute myocardial infarction in the Arctic region of Russia (Yakutsk) among those aged 25–64 years (WHO program "Register of acute myocardial infarction"). Byulleten' Sibirskogo Otdeleniya Rossiyskoy Akademii Meditsinskikh Nauk 2010; 30(3): 64–70. Russian (Гафаров В.В., Горохова Е.В., Гафарова А.В., Татаринова В.В. Острый инфаркт миокарда в арктическом регионе России (г. Якутск) среди населения в возрасте 25–64 лет (программа ВОЗ ≪Регистр острого инфаркта миокарда≫). Бюллетень Сибирского Отделе- ния Российской Академии Медицинских Наук 2010; 30(3): 64–70).
20. Erlikh A.A., Gratsianskiy N.A. The results of the six-month follow up of patients with acute coronary syndromes in the RECORD Russian register. Kardiologiia 2011; 51(12): 11–16. Russian (Эрлих А.А., Грацианский Н.А. Результаты шестимесячного наблюдения за больными с острыми коронарными синдромами в Российском регистре РЕКОРД. Кардиология 2011; 51(12): 11–16).
21. Erlikh A.D., Gratsianskiy N.A. Acute coronary syndrome without ST elevation in the real practice of Russian hospitals. Comparative data registers "RECORD-2" and "RECORD" Kardiologiia 2012;(10): 9–16. Russian (Эрлих А.Д., Грацианский Н.А. Острый коронарный синдром без подъемов ST в реальной практике российских стационаров. Сравнительные данные регистров ≪РЕКОРД-2≫ и ≪РЕКОРД≫ Кардиология 2012;(10): 9–6).
22. Kosmacheva E.D., Pozdnyakova O.A., Kruberg L.K. et al. The first results of the register of acute coronary syndromes in the Krasnodar region. Aterotromboz 2010; (1): 109–14. Russian (Космачева Е.Д., Позднякова О.А., Круберг Л.К. и др. Первые результаты регистра острых коронарных синдромов в Краснодарском крае. Атеротромбоз 2010; (1): 109–14).
23. Belenkov Yu. N., Mareev V. Yu., Ageev F. T. et al. The true prevalence of heart failure in the European part of the Russian Federation (the study of the era, the hospital stage. Serdechnaya Nedostatochnost' 2011;12(2): 63–8. Russian (Беленков Ю. Н., Мареев В. Ю., Агеев Ф. Т. и др. Истинная распространенность ХСН в Европейской части Российской Федерации (исследование ЭПОХА, госпитальный этап. Сердечная Недостаточность 2011;12(2): 63–8).
24. Gliklich RE, Dreyer NA, eds. Registries for Evaluating Patient Outcomes: A User’s Guide. 2nd ed. Rockville (MD): Agency for Healthcare Research and Quality (US); 2010.
Review
For citations:
Boytsov S.A., Yakushin S.S., Martsevich S.Yu., Lukyanov M.M., Nikulina N.N., Zagrebelny A.V., Vorobyov A.N., Pereverseva K.G., Pravkina E.A., Deev A.D., Andreenko E.Yu., Ershova A.I., Meshkov A.N., Myasnikov R.P., Serdyuk S.E., Kharlap М.S. OUTPATIENT REGISTER OF CARDIOVASCULAR DISEASES IN THE RYAZAN REGION (RECVASA): PRINCIPAL TASKS, EXPERIENCE OF DEVELOPMENT AND FIRST RESULTS. Rational Pharmacotherapy in Cardiology. 2013;9(1):4-14. https://doi.org/10.20996/1819-6446-2013-9-1-4-14
Views: 1232
Email this article 