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Multimorbidity, outcomes and preventive pharmacotherapy in patients with history of stroke: data of outpatient registry REGION

Session Poster Session 2

Speaker Assistant Professor Mikhail Lukiyanov

Congress : ESC Preventive Cardiology (Formerly EuroPrevent) 2019

  • Topic : preventive cardiology
  • Sub-topic : Secondary Prevention
  • Session type : Poster Session
  • FP Number : P528

Authors : OM Drapkina (Moscow,RU), MM Lukiyanov (Moscow,RU), SY Martsevich (Moscow,RU), EY Okshina (Moscow,RU), SS Yakushin (Ryazan,RU), AN Vorobyev (Ryazan,RU), AV Zagrebelniy (Moscow,RU), AN Kozminsky (Ryazan,RU), KA Moseichuk (Ryazan,RU), KG Pereverzeva (Ryazan,RU), EA Pravkina (Ryazan,RU), EY Andreenko (Moscow,RU), VG Klyashtorny (Moscow,RU), EV Kudryashov (Moscow,RU), SA Boytsov (Moscow,RU)

Authors:
OM Drapkina1 , MM Lukiyanov1 , SY Martsevich1 , EY Okshina1 , SS Yakushin2 , AN Vorobyev2 , AV Zagrebelniy1 , AN Kozminsky2 , KA Moseichuk2 , KG Pereverzeva2 , EA Pravkina2 , EY Andreenko1 , VG Klyashtorny1 , EV Kudryashov1 , SA Boytsov3 , 1National Research Center for Preventive Medicine - Moscow - Russian Federation , 2Ryazan State Medical University - Ryazan - Russian Federation , 3National Medical Research Center for Cardiology - Moscow - Russian Federation ,

Citation:

Aim. To evaluate multimorbidity, drug therapy, outcomes and risk of main cardiovascular (CV) events in patients with history of stroke (HStr) enrolled in outpatient registry in the Ryazan Region. 

Methods. The total of 986 patients with HStr (age 70.6±10.9; 57% women) applied for doctors of 3 outpatient clinics were enrolled in the REGION registry. The mean number from 4 CVD (hypertension, coronary artery disease, chronic heart failure, atrial fibrillation - AF) and from 6 nonCVD (diabetes, chronic obstructive pulmonary disease - COPD, chronic kidney disease, obesity, anemia, digestive diseases) was estimated as well as an incidence of drug administration. End points were evaluated at 3-year follow-up period. Cox model was used to estimate the hazard ratio, 95% confidential interval for prediction of cardiovascular mortality (CVM) and risk of main acute CV events - MACE (CVM, nonfatal stroke, nonfatal myocardial infarction - MI).

Results. The most of patients - 826 (83.8%) had CV multimorbidity (2-4 CVD). The average number of CVD was 2.6±0.8 and of nonCVD – 1.7±0.5. Incidence of administration of ACE inhibitors (ACEI) was 30.6%, angiotensine receptor blockers (ARB) - 10.0%, beta-blockers – 20.6%, statins – 13.8%, antiplatelets – 31.3%, anticoagulants – 3.2%, calcium channel blockers – 14.2%, diuretics – 26.4%. During follow-up period (2.9±0.7 years) 308 (31.2%) patients died, including 242 (24.5%) from CVD. There were 43 (4.4%) and 16 (1.6%) cases of nonfatal stoke and nonfatal MI. The next factors were significant for increase of risk of CVM and MACE: age – 1.11 (1.09-1.13) and 1.08 (1.06-1.09); sex (for men) - 1.86 (1.38-2.50) and 1.73; 1.32-2.27), AF - 1.55 (1.15-2.09) and 1.46 (1.11-1.93); COPD - 1.89 (1.28-2.79) and 1.48 (1.01-2.17); history of recurrent stroke - 1.92 (1.40-2.63) and 1.70 (1.27-2.28); history of MI (only for MACE) - 1.44 (1.06-1.94); heart rate >80/min - 1.63 (1.18-2.25) and 1.53 (1.14-2.06); no antihypertensive treatment (AHT) for hypertension - 1.94 (1.30-2.89) and 2.02 (1.41-2.89); low Hb (<120g/l for women and <130g/l for men) - 2.44 (1.49-4.00) and 2.12 (1.35-3.34). These factors were significant for reduction of risk of CVM and MACE - administration of: ACEI - 0.62 (0.42-0.93) and 0.48 (0.33-0.69); ARB - 0.27 (0.13-0.55) and 0.45 (0.46-0.92); beta-blockers - 0.75 (0.14-0.51) and 0.65 (0.46-0.92); statins - 0.52 (0.35-0.76) and 0.71 (0.51-0.98).

Conclusions. The REGION study revealed CV multimorbidity in 84% of patients with HStr. Average number of CVD and nonCVD was 4.3. Incidence of administration of antiplatelets (31%), ACEI (31%), diuretics (26%). beta-blockers (21%) was bigger than for other drugs. The risk of CVM and MACE was significantly higher during 3-year follow-up period in patients with AF, COPD, history of MI and recurrent stroke, heart rate>80/min, low Hb, no AHT for hypertension. In patients with administration of ACEI, ARB, beta-blockers and statins risk of CVM and MACE was 1.4–3.7 times less.



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