Русский
Analysis of the structure of comorbidities and pharmacotherapy in patients with a combination of atrial fibrillation and coronary heart disease
DOI: https://dx.doi.org/10.18565/pharmateca.2023.14.68-77
A.V. Dubinina, A.I. Kochetkov, A.E. Vorobyova, S.S. Eremina, K.B. Mirzaev, O.D. Ostroumova
1) Russian Medical Academy of Continuous Professional Education, Moscow, Russia; 2) I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
Background. Atrial fibrillation (AF) and coronary heart disease (CHD) mutually worsen the course and prognosis of each other, especially in the presence of a history of previous myocardial infarction. Such a combination of diseases is more common in elderly and senile patients, which requires special control of pharmacotherapy due to the high prevalence of polypharmacia.
Objective. Analysis of the structure of comorbidities and compliance of prescribed pharmacotherapy with STOPP/START criteria in hospitalized patients ≥65 years old with a combination of AF and CHD, depending on the presence of previous myocardial infarction. Methods. We conducted a retrospective analysis of the medical histories of 342 patients ≥65 years old with a combination of AF and CHD who were treated in the cardiology department of a multidisciplinary hospital in Moscow, and divided them into groups: group 1 – 214 patients, median age 85 (78–90) years without history of previous myocardial infarction and a group 2 – 128 patients, median age 85.5 (78–90) years with a history of previous myocardial infarction. The comparative analysis of the structure of multimorbidity and pharmacotherapy according to STOP/START criteria was carried out.
Results. In the second group, the score on the CHA2DS2-VASc (p<0.001), the value of the Charlson comorbidity index (p<0.001), and the number of maximally prescribed drugs at the same time (p=0.002) were significantly higher. Among the comorbidities in patients with a history of previous myocardial infarction, there were chronic heart failure of functional class IV according to the New York Heart Association (NYHA) classification (p=0.006), type 2 diabetes mellitus (p=0.005), stage 3b chronic kidney disease (p=0.019) more common. START criteria were more common than STOPP criteria, and we also found two START criteria with significant differences in frequency between groups.
Conclusions. The data obtained requires more careful selection of medicines in elderly patients. STOPP/START criteria can be recommended to use to select the optimal treatment strategy.
Objective. Analysis of the structure of comorbidities and compliance of prescribed pharmacotherapy with STOPP/START criteria in hospitalized patients ≥65 years old with a combination of AF and CHD, depending on the presence of previous myocardial infarction. Methods. We conducted a retrospective analysis of the medical histories of 342 patients ≥65 years old with a combination of AF and CHD who were treated in the cardiology department of a multidisciplinary hospital in Moscow, and divided them into groups: group 1 – 214 patients, median age 85 (78–90) years without history of previous myocardial infarction and a group 2 – 128 patients, median age 85.5 (78–90) years with a history of previous myocardial infarction. The comparative analysis of the structure of multimorbidity and pharmacotherapy according to STOP/START criteria was carried out.
Results. In the second group, the score on the CHA2DS2-VASc (p<0.001), the value of the Charlson comorbidity index (p<0.001), and the number of maximally prescribed drugs at the same time (p=0.002) were significantly higher. Among the comorbidities in patients with a history of previous myocardial infarction, there were chronic heart failure of functional class IV according to the New York Heart Association (NYHA) classification (p=0.006), type 2 diabetes mellitus (p=0.005), stage 3b chronic kidney disease (p=0.019) more common. START criteria were more common than STOPP criteria, and we also found two START criteria with significant differences in frequency between groups.
Conclusions. The data obtained requires more careful selection of medicines in elderly patients. STOPP/START criteria can be recommended to use to select the optimal treatment strategy.
Keywords: STOPP/START criteria, polypharmacia, previous myocardial infarction, multimorbidity, adverse drug reactions, old age, coronary heart disease, atrial fibrillation
About the Autors
Corresponding author: Alexey I. Kochetkov, Cand. Sci. (Med.), Associate Professor of the Department of Therapy and Polymorbid Pathology
n.a. Academician M.S. Vovsi, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; ak_info@list.ru
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