Quality of medication therapy in patients after stroke depending on presence/absence of diabetes: data from the outpatient stage of REGION-M registry

Aim. To study the features of treatment of patients with various types of coronary artery disease (CAD) and type 2 diabetes (T2D) at various healthcare stages.Material and methods. The comparative clinical study included 412 patients of both sexes with acute and chronic coronary artery disease. Depending on the glycemic status and CAD type, patients were divided into four subgroups: subgroup 1a (n=100, 56,6±0,96 years, male/female 67/33) — with acute CAD and T2D; subgroup 1b (n=106, 58,7±1,01 years, male/female 75/31) — with acute CAD without T2D; subgroup 2a (n=102, 57,9±1,04 years, male/female 72/30) — with chronic CAD and T2D; subgroup 2b (n=104, 60,2±0,9 years, 69/35) — with chronic CAD without T2D. The selection and mean doses of standard and hypoglycemic therapy were analyzed.Results. Initially, 86% and 81% of patients with diabetes in subgroups 1a and 2a adhered to glucose-lowering therapy. Among patients with chronic CAD, more than 1/4 (26,4%) received insulin therapy versus 2% in the group of patients with acute coronary syndrome (ACS) and diabetes. After discharge from hospital, oral hypoglycemic therapy was prescribed to 74% of patients with ACS and 48% of patients with chronic CAD. The prescription of insulin therapy for people with ACS increased 5 times (up to 10% of the total number of patients with ACS and T2D). By the time of hospital admission, 70% and 71,5% of patients with ACS and chronic CAD with diabetes received acetylsalicylic acid as an antiplatelet agent, respectively. During hospitalization, all patients with acute CAD were prescribed dual antiplatelet therapy, as well as triple antiplatelet therapy in the case of atrial fibrillation/flutter. It is noteworthy that in the group of patients with chronic CAD, less than 70% received statins. In patients with chronic CAD and diabetes, this parameter was even lower, amounting to 59,8%. At the outpatient stage, all patients, with the exception of the group with chronic CAD without diabetes, took beta-blockers (up to 65%). In the hospital, the use of beta blockers increased to 95%. During inpatient treatment, angiotensin-converting enzyme inhibitors and sartans were prescribed 1,5-2 times more often than in the prehospital stage.Conclusion. The study indicates insufficient prescription of standard CAD and glucose-lowering therapy. Careful inpatient selection of therapy requires continuity at the outpatient stage.

Section: Discussionunclassified

Comparative analysis of pharmacotherapy for patients with coronary artery disease and type 2 diabetes at various healthcare stages

Kokozheva,

Mardanov,

Mamedov

2024

Long-term survival of patients with cerebrovascular accident in different age groups in the REGION-M registry

Толпыгина¹,

Zagrebelnyy²,

Чернышева

et al. 2023

Self Cite

Aim. To study the two-year survival rate of patients with cerebrovascular accident (CVA) in different age groups.Material and methods. The outpatient part of the REGION-M registry included 684 patients assigned to the City Polyclinic № 64 in Moscow, discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a confirmed diagnosis of stroke or transient ischemic attack. All patients were divided into 5 age groups: group 1 — from 18 to 50 years old (n=72 (10,5%)), group 2 — from 51 to 60 years old (n=122 (17,8%)), group 3 — from 61 to 70 years old (n=156 (22,8%)), group 4 — from 71 to 80 years old (n=185 (27,0%)) and group 5 — 81 years and above (n=149 (21,8%)). Patient survival was assessed after 2 years of follow-up.Results. The mortality rate of patients during the follow-up period significantly increased with age as follows: in patients of 18-50 years old — 4%, 51-60 years old — 9,8%, 61-70 years old — 23,7%, 71-80 years old — 34%, 81-100 years old — 55% (p<0,0001). The relative death risk was 2,3 in group 2 (NA), 6,8 in group 3 (p<0,001), 9,8 in group 4 (p<0,0001) and 18,5 in group 5 (p<0,0001) compared with group 1. With increasing age in the study cohort, the proportion of women increased as follows: from 47,2% in group 1 to 77,9% in group 5 (p<0,0001). However, mortality among men and women in the groups did not differ. Patients in older age groups were more likely to have comorbidities and disability before the CVA. With increasing age, ischemic stroke was significantly more common and transient ischemic attack was less common (p<0,001).Conclusion. Mortality of patients who underwent stroke was significantly higher in older age groups and did not differ among men and women.

Medical follow-up and long-term survival of patients with cerebrovascular accident: data from the REGION-M registry

Tolpygina,

Chernysheva,

Zagrebelny

et al. 2023

Self Cite

Aim. To assess the survival rate of patients after cerebrovascular accident (CVA), depending on the visits to the local outpatient clinic and the type of medical supervision, and in the first year after hospital discharge.Material and methods. The outpatient part of the REGION-M registry included 684 patients assigned to the City Polyclinic № 64 of Moscow, discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a confirmed diagnosis of cerebral stroke/transient ischemic attack.Results. During the first year after the CVA, 451 (65,9%) patients visited the local clinic on their own (group 1), while 166 (24,3%) patients was consulted by house call (group 2), and 67 (9,8%) did not see the physician (group 3). Patients visited by house call were more likely to have prior coronary artery disease and stroke, and the age of men was older than in other groups. Patients who did not see a doctor were less likely to have comorbidities and disabilities, and were less likely to visit the clinic before stroke. The mortality of patients in group 3 was significantly higher throughout the entire follow-up period (55,2%, 70,1% and 77,6% at stages 1, 2 and 3 (p<0,001), respectively) than in group 2 (31,2%, 55,4% (p<0,001)) and group 1 (23,7%, 37,0% and 54,3% (p<0,001)). Mortality of patients in group 1 was lower than group 2 (p<0,05-0,01). The relative risk of death in clinic visitors was 0,450 (95% confidence interval (CI), 0,333-0,608, p<0,0001), while in those visited by a doctor at home — 0,668 (95% CI, 0,482-0,927, p<0,05). In multivariate analysis and adjustment for sex and age (relative risk (RR) of death, 0,08 (95% CI, 0,048-0,133), p<0,0001 and 1,036 (95% CI, 1,031-1,042), p<0,001, respectively), the independent contribution of the factor of clinic visits was preserved. Thus, the RR of death in visitors was 0,996 (95% CI, 0,994-0,999), p<0,001 and 0,998 (95% CI, 0,995-1,0), p<0,05.Conclusion. The lower mortality among those visited the local clinic in the first year after CVA and among those who were visited by a doctor at home, compared with patients who were not observed, confirms the important role of medical supervision in the post-hospital period.