Patients with Combination of Cardiovascular Diseases and Type 2 Diabetes in RECVASA and REGION Registries: Multimorbidity, Outcomes and Potential Effect of Dapagliflozin in the Russian Clinical Practice

Abstract

Aim. To evaluate the structure of multimorbidity, outcomes and the potential effect of dapagliflozin in patients with a combination of cardiovascular disease (CVD) and type 2 diabetes in Russian clinical practice.Material and methods. The data of 10 registries with the inclusion of 22957 people, including 4370 with type 2 diabetes in 6 regions of the Russian Federation, were analyzed. Scenarios for reducing mortality from all and cardiovascular causes and hospitalizations for CVD were simulated among groups of patients with diabetes combined with myocardial infarction (MI) and diabetes combined with heart failure with reduced ejection fraction (HFrEF) based on data from the Federal Registry of diabetes, the RECVASA and REGION registries, relative risks associated with analyzed adverse events from the DECLARE study.Results. When analyzing the data of all 22957 patients with CVD included in the registries, it was found that the proportion of patients with comorbid diabetes was on average 19.0%. Of the various diagnoses of CVD, the combination with diabetes was most often recorded in patients that had MI – 2.0%, stroke – 22.5% and heart failure – 24.0%. In the RECVASA registry (Ryazan) for 4 years of follow-up of 699 patients with a combination of CVD and diabetes mortality from all causes was 20.9%, and from cardiovascular causes – 15.6%. The simulated number of potentially prevented cardiovascular deaths with dapagliflozin taking in patients with diabetes combined with MI for 4 years in Russia will be 39124, and 37440 cardiovascular hospitalizations. The number of potentially preventable deaths from all causes among patients with diabetes combined with HFrEF will be 4543, cardiovascular deaths in 1995, and the number of prevented cardiovascular hospitalizations will be 7072.Conclusion. According to data from the registries of CVD patients in 6 regions of the Russian Federation, it was revealed that in real clinical practice the proportion of people with comorbid diabetes averaged 19% both at the outpatient and hospital stages. These subgroups of multimorbid patients have both the highest risk of developing fatal and non-fatal cardiovascular complications, and the largest number of indications for prescribing drugs that affect the prognosis due to effects on both CVD and diabetes.

Socio-economic impact of heart failure in Russia

“…Источником данных, на основании которых при моделировании оценивался экономический ущерб в РФ, обусловленный смертностью, затратами на госпитализации и медикаментозное лечение больных с ХСН, были сведения, полученные из медицинских регистров РЕКВАЗА (Рязань), РЕКВАЗА ФП -Курск, РЕКВАЗА ФП -Москва, РЕКВАЗА ФП -Ярославль, РЕГИОН-ПО (Рязань), РЕГИОН-ЛД (Рязань), РЕГИОН-Москва и РЕГАТА (Рязань). Подробнее данные регистры были описаны в ранее опубликованных исследованиях [9][10][11][12][13][14]. Из этих проспективных регистров были извлечены сведения за все время наблюдения о числе госпитализаций, случаях смерти, назначаемой лекарственной терапии было основано на том, что наличие IV ФК ХСН соответствует III-IV степени выраженности стойких нарушений функций организма человека в соответствии с количественной системой оценки, предусмотренной приложением к "Классификациям и критериям", используемым при осуществлении медико-социальной экспертизы граждан федеральными государственными учреждениями медико-социальной экспертизы, т.е.…”