NOSOLOGICAL STRUCTURE OF ACUTE CORONARY EVENTS AT ADMISSION AND AT DISCHARGE, PATIENT COMPLIANCE AND NEAREST FORECAST (DATA OF THE RACSMI-UZ REGISTER)

Introduction. Basing on the data of the “RACSMI-UZ” register, the article provides comparative analysis of the structure and transformation of diagnoses during acute coronary conditions in the dynamics (at admission and discharge), assesses patients' adherence to drug therapy depending on gender and also describes analysis of its effect on the short-term prognosis.

Material and methods. The study material included 449 patients with ACS/AMI hospitalized to relevant health care facilities of the experimental district of Tashkent. Two groups of patients were distinguished depending on the gender: group 1 included 243 male patients, and group 2 consisted of 206 female patients.

Results. The registration showed that ACS/AMI was more often observed in men than in women (54.1% vs. 45.9%, respectively). Male patients proved to be younger than female ones (p <0.05); obesity of different degree prevailed in women (48.0% in women vs. 29.6% in men, p <0.05). In the male population, AMI at admission was registered in 43 (17.7%) patients but the number of patients with this diagnosis increased at discharge (61 subjects, or 25.1%). Out of 243 men, 3.7% died and the largest number of deaths occurred in patients with initial diagnosis of unstable angina. In the female population, the incidence of AMI both with and without Q at admission was recorded 2 times less frequent than that at discharge from the hospital (8.7% of cases at admission and 17.5% of cases at discharge), which shows low vigilance of healthcare professionals in diagnostics of AMI in women. Mortality from ACS/ AMI in women was 3.4% with the largest number of deaths being associated with the initial diagnosis of AMI without Q. Compliance in females was somewhat higher than in males; men were prone to taking more medications (Mc’s), though there were no significant differences between men and women by the proportion of Mc’s taken. The direct correlation was found between the patients’ compliance level and the time interval: from admission to death of the respondent (p> 0.05).

Conclusion. ACS / AMI was more often recorded in men than in women, while the age of men was younger (p<0.05). Alertness of primary care physicians in ACS / AMI was low, especially for women. Compliance in women was higher than in men. Thus, the higher was the patient adherence to therapy, the more stable the body appeared to cardio stress.

1. Alpert J.S. Are data from clinical registries of any value? Eur Hear. J. 2000; 21(17):1399-1401.

2. O’Shea J.C., Calif R.M. Inter-regional differences in acute coronary syndrome trials. Eur Hear. J. 2000;21(17):1397-1399.

3. Gafarov V.V., Gafarova A.V., Blaginina M.Yu. The WHO program “Register of acute myocardial infarction”: a 25-year epidemiological study of myocardial infarction in Russia (1977-2001). Cardiology. 2005;8:48-50 [in Russian].

4. Kosmacheva E.D., Pozdnyakova O.A., Kruberg L.K. et al. The first results of the register of acute coronary syndromes in the Krasnodar region. Atherothrombosis. 2010;1(4):109-114 [in Russian].

5. Oshchepkova E.V. Mortality of the population from cardiovascular diseases in the Russian Federation and ways to reduce it. Cardiology. 2009.2:267-272 [in Russian].

6. Erlich A.D., Gratsiansky N.A. Acute coronary syndrome without ST elevations in the real practice of Russian hospitals. Comparative data registers “RECORD-2” and “RECORD”. Cardiology. 2012;10:9-16 [in Russian].

7. Granger C.B., Goldberg R.J., Dabbous O.M. et al. Predictors of hospital mortality in the Global Registry of Acute Coronary Events. Arch Int Med. 2003;163: 2345-53.

8. Fox K.A., Poole-Wilson P., Clayton T.C., Henderson R.A. et al. 5-year outcome of an interventional strategy in non-STelevation acute coronary syndrome: the British Heart Foundation RITA 3 randomised trial / Lancet. 2005;366(9489):914-920.

9. Peterson S., Peto V., Rayner M. et al. European Cardiovascular Disease Statistics, 2nd edn. London: British Heart Foundation, 2005.

10. Svistov A.S., Galiullina R.Kh., Obrezan A.G. Features of risk factors for coronary artery disease, exercise test samples, 24-hour ECG monitoring and coronary angiography in young women with myocardial infarction. Cardiology. 2003; 3:54-58 [In Russian].

11. Makolkin V.I. Optimization of treatment of stable angina. Consilium Medicum. 2007; 9(5):44-48 [in Russian].

12. Gleser M.G., Saigitov R.T., Sementsov D.P. et al. Acute coronary syndrome in the elderly: a prognosis for hospital mortality. Wedge. geront. 2005; 11(1):13-20 [in Russian].

13. Hasdai D., Behar S., Wallentin L. et al. A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; the Euro Heart Survey of Acute Coronary Syndromes. Eur Heart J. 2002; 23(15):1190-201.

14. Hochman J.S., McCabe C.H., Stone P.H. et al. Outcome and profile of women and men presenting with acute coronary syndromes: a report from TIMI IIIB. JACC. 1997;30:141-8.

15. Rosengren A., Wallentin L., Gitt A. et al. Sex, age, and clinical presentation of acute coronary syndromes. Eur Heart J. 2004; 25(8):663-670.

16. Fiebach N.H., Viscoli C.M., Horwitz R.I. Differences between women and men in survival after myocardial infarction. Biology or methodology? JAMA. 1990; 263(8):1092-1096.

17. Wang W., Lau Y., Loo A. et al. Medication adherence and its associated factors among Chinese community-dwelling older adults with hypertension. Heart Lung. 2014; 43(4):278-283.

18. Fodor G.J., Kotrec M., Bacskai K. et al. Is interview a reliable method to verify the compliance with antihypertensive therapy? An international Central-European study. J Hypertens. 2005; 23:1261-1266.

19. Rao C.R., Veena K.G., Shetty A. et al. Treatment Compliance among patients with hypertension and type 2 diabetes mellitus in a coastal population of Southern India. Int J Prev Med. 2014; 5(8):992-998.

20. Raymundo NAC, Pierin AMG. Adherence to anti-hypertensive treatment within a chronic disease management program: A longitudinal, retrospective study. Rev Esc Enferm USP. 2014; 48(5):809-817