Русский
Pharmacotherapy of elderly multimorbid patients with atrial fibrillation in real clinical practice: practical application of STOPP/START criteria
DOI: https://dx.doi.org/10.18565/pharmateca.2024.4.24-33
Kochetkov A.I., Telkova S.S., Dubinina A.V., Mirzaev K.B., Shastina V.R., Cherniaeva M.S., Dashabylova V.B., Ostroumova O.D.
1) Russian Medical Academy of Continuous Professional Education, Moscow, Russia; 2) Veterans Hospital No 2, Moscow, Russia; 3) I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
Background. Atrial fibrillation (AF) is one of the most common atrial arrhythmias. Concomitant coronary heart disease (CHD) and myocardial infarction in patients with AF increase the risk of thromboembolic events, and anemia of any etiology increases the risk of bleeding. Among the groups of comorbid patients, the control of pharmacotherapy is most important, given the widespread prevalence of polypragmasy.
Objective: to analysis of pharmacotherapy for compliance with STOPP/START criteria in hospitalized patients 65 years and older with a combination of AF and postinfarction cardiosclerosis (PIC) or anemia.
Methods. In a multidisciplinary hospital in Moscow, in the period from August 1, 2022 to January 31, 2023, medical histories of patients aged 65 years and older with AF were selected for retrospective analysis, then high-risk groups of patients were identified: 75 patients with AF and anemia in the therapeutic department and 33 patients with AF and PIC, in the cardiology department – 81 and 88 patients, respectively. Next, the analysis of the prescribed pharmacotherapy for compliance with the criteria of STOPP/START 2 version.
Results. More than 95% of those hospitalized in each subgroup received ≥ 5 medications daily. 90% of those hospitalized in the therapeutic department and 72–73% of those hospitalized in the cardiology department had at least one START criterion. The most missed prescriptions were clopidogrel with ischemic stroke or a documented history of peripheral vascular disease, beta blockers with ischemic heart disease, ACE inhibitors in patients with chronic heart failure, and statins in patients with a history of coronary, cerebral or peripheral vascular disease. STOPP criteria were found in an average of half of the patients in both departments. Drugs with anticholinergic activity have become the most frequent inappropriate prescriptions.
Conclusion. The results obtained allow us to conclude that it is necessary to use STOPP/START criteria, as well as the anticholinergic load score, to optimize pharmacotherapy for elderly and senile patients in real clinical practice.
Objective: to analysis of pharmacotherapy for compliance with STOPP/START criteria in hospitalized patients 65 years and older with a combination of AF and postinfarction cardiosclerosis (PIC) or anemia.
Methods. In a multidisciplinary hospital in Moscow, in the period from August 1, 2022 to January 31, 2023, medical histories of patients aged 65 years and older with AF were selected for retrospective analysis, then high-risk groups of patients were identified: 75 patients with AF and anemia in the therapeutic department and 33 patients with AF and PIC, in the cardiology department – 81 and 88 patients, respectively. Next, the analysis of the prescribed pharmacotherapy for compliance with the criteria of STOPP/START 2 version.
Results. More than 95% of those hospitalized in each subgroup received ≥ 5 medications daily. 90% of those hospitalized in the therapeutic department and 72–73% of those hospitalized in the cardiology department had at least one START criterion. The most missed prescriptions were clopidogrel with ischemic stroke or a documented history of peripheral vascular disease, beta blockers with ischemic heart disease, ACE inhibitors in patients with chronic heart failure, and statins in patients with a history of coronary, cerebral or peripheral vascular disease. STOPP criteria were found in an average of half of the patients in both departments. Drugs with anticholinergic activity have become the most frequent inappropriate prescriptions.
Conclusion. The results obtained allow us to conclude that it is necessary to use STOPP/START criteria, as well as the anticholinergic load score, to optimize pharmacotherapy for elderly and senile patients in real clinical practice.
Keywords: соronary artery disease, STOPP/START criteria, polymorbidity, polypragmasy, old age, anemia, atrial fibrillation
About the Autors
Corresponding author: Olga D. Ostroumova, Dr. Sci. (Med.), Professor, Head of the Department of Therapy and Polymorbid Pathology n.a. Academician M.S. Vovsi, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation; Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases of the I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ostroumova.olga@mail.ru
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