Drug therapy in elderly patients with myocardial infarction

DOI: https://dx.doi.org/10.18565/pharmateca.2022.13.80-86

S.V. Malchikova, N.S. Trushnikova, M.V. Kazakovtseva, N.S. Maksimchuk-Kolobova

Kirov State Medical University, Kirov, Russia
Background. The growing aging of the population creates the need for research to assess the tactics and effectiveness of providing care to patients of older age groups, the dynamics of prescribed therapy at all stages of myocardial infarction (MI) and in the late post- infarction period.
Objective. Evaluation of the drug therapy in elderly patients with MI as part of an observational study.
Methods. A retrospective-prospective observational study (follow-up period – 12 months) included 92 patients with myocardial infarc- tion aged 75 to 93 years. Primary end point: in-hospital death at 3 months and 1 year. Secondary end points: hospitalization, bleeding, stroke, acute coronary syndrome, decompensation of chronic heart failure, the proportion of patients continuing to take cardiac drugs at 3 and 12 months.
Results. Most patients had a set of different risk factors and concomitant cardiovascular diseases, however, the frequency of prescribing
cardiac drugs did not correspond to them before the present MI (43.5% took the renin-angiotensin system (RAAS) inhibitors, 33.7% – β-blockers (BB), 30.4% – statins, and 46.7% – antiplatelet agents). The rate of coronary revascularization was 30.4%. During hospitaliza- tion, the proportion of patients receiving RAAS inhibitors increased to 76% (P=0.000), BB – up to 88% (P=0.000), diuretics – up to 51.1% (P=0.000), mineralocorticoid receptor antagonists – up to 15.2 %, statins – up to 100% (P=0.000), antiplatelet agents – up to 98.9% (P=0.000). The use of STOPP/START criteria revealed that 31.5% of patients were prescribed potentially non-recommended drugs, and 40.2% had a potential omission in prescribing drugs. Three months after MI, there was a decrease in the proportion of patients taking life- saving drugs, and this trend continued until the end of the year. 12 months after inclusion in the study, 16.3% of patients died. The main complications, including fatal ones, were associated with repeated ischemic events (29.3% of cases) or bleeding (4.3%).
Conclusion. Frequent prescription of potentially non-recommended drugs can cause adverse reactions, and insufficient use of vital drugs, which is especially noticeable in the post-infarction period, increases the risk of adverse clinical outcomes for elderly patients with myocardial infarction.

About the Autors

Corresponding author: Svetlana V. Malchikova, Dr. Sci. (Med.), Associate Professor, Professor at the Department of Hospital Therapy, Kirov State Medical University, Kirov, Russia; malchikova@list.ru

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