The analysis of compliance of pharmacotherapy of patients with myocardial infarction to the principles evidence-based medicine at the stage of rehabilitation in modern conditions

Abstract

Соответствие фармакотерапии пациентов после инфаркта миокарда принципам доказательной медицины на этапе реабилитации в современных условиях И.М. БУРЫКИН, Г.Н. АЛЕЕВА, Р.Х. ХАФИЗЬЯНОВА ГБОУ ВПО «Казанский государственный медицинский университет» Минздрава России, Казань, Россия Острый инфаркт миокарда является одной из причин социальных и экономических потерь общества. Успехи последних лет в терапии данного заболевания выводят на первый план вопросы эффективной реабилитации после стационарного лечения. Внедрены новые методы, разработаны руководства и стандарты для врачей, однако эффективность реабилита-ции в Российской Федерации ниже, чем в зарубежных странах. Для разработки путей дальнейшего совершенствования методики восстановления больных после острого инфаркта миокарда был проведен анализ эффективности реабилитации и фармакоэпидемиологическое исследование на базе санаторно-курортного учреждения в 2006 и 2009 г. Цель -прове-сти анализ соответствия реальной клинической практики ведения больных после острого инфаркта миокарда на этапе реабилитации принципам доказательной фармакотерапии. Goal. Acute myocardial infarction is one of the causal factors of society and economic losses of companionship. Success in the treatment of acute myocardial infarction raises questions on the effective rehabilitation of the first places. New methods, clinical guidelines and standards have been introduced into clinical practice. However, the effectiveness of rehabilitation in the Russian Federation lower than developed countries. The present study was aimed to improve rehabilitation care to patients after acute myocardial infarction. Analysis of the effectiveness of rehabilitation and pharmacoepidemiological studies was conducted on the basis of a medical spa facility in 2006 and 2009. Materials and methods. Experts form and database were developed to achieve the objectives. Quantitative assessments were carried out on the basis of the developed quality indicators. We used pharmacoepidemiological and statistical methods in the study. Results. Myocardial infarction was often combined with hypertension (73.8% and 61.9%) and chronic heart failure (87.6% and 85.8%). Patients had a high prevalence of risk factors: smoking (46.1% and 42.3%), overweight (53.8% and 67.2%), dyslipidemia (44.6% and 66.1%) in 2006 and 2009, respectively. Rehabilitation includes physical exercise, mineral baths, swimming pool. The average number of drugs of rehabilitation stage was 4,46±0,12 and 4,11±0,11. Beta-blockers are indicated for all patients after acute myocardial infarction, and they were prescribed in 86.1% and 90.1% of cases. Drugs affecting renin-angiotensin system were in second place frequency of prescribing. These drugs are prescribed in 67.6% and 41.7% patients. The frequency of prescribing of statins increased by 5.8 times from 2006 to 2009 and reached 81.32%. Conclusions. Rehabilitation and pharmacotherapy in patients after acute myocardial infarction corresponds to ОРИГИНАЛЬНЫЕ СТАТЬИ