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Effectiveness of treatment and risk factor modification in elderly and senile patients with coronary artery disease before myocardial revascularization

Session Poster Session 2

Speaker Ekaterina Lubinskaya

Congress : EuroPrevent 2019

  • Topic : preventive cardiology
  • Sub-topic : Secondary Prevention
  • Session type : Poster Session
  • FP Number : P551

Authors : T Petrova (Saint Petersburg,RU), E Lubinskaya (Saint Petersburg,RU), N Moroshkina (Saint Petersburg,RU), E Demchenko (Saint Petersburg,RU)

Authors:
T Petrova1 , E Lubinskaya2 , N Moroshkina2 , E Demchenko2 , 1First Pavlov State Medical University of St. Petersburg - Saint Petersburg - Russian Federation , 2Almazov National Medical Research Centre - Saint Petersburg - Russian Federation ,

Citation:

Background. Coronary artery disease (CAD) is the main cause of mortality in developed countries (53.3%). The number of elderly and senile patients undergoing myocardial revascularization, including coronary artery bypass grafting (CABG), increases progressively because of a positive tendency to increase longevity of the population. Optimal medical therapy, adequate risk factor modification is a crucial component of effective prehabilitation, reduction incidence of perioperative complications and successful rehabilitation of patients after surgery.

Purpose. Assessment of the patients compliance and level of cardiovascular risk factors modification in elderly and senile CAD patients before myocardial revascularization.

Methods. 86 elderly and senile CAD patients (60-89 y.o., middle age 71,5±12,3, 56% male) being admitted to the hospital for myocardial revascularization. Information about ambulatory / out-patient care before hospitalisation for myocardial revascularization before surgery was obtained by patient survey and analyzing previous medical records.

Results. 47,8% patients followed the diet, 31% persons had stopped smoking, 60,5% were regularly observed by a cardiologist, 45,3% patients received regular drug therapy at least 6 months before surgery. Statins were prescribed to 66,3% patients, beta-blockers – 67,4%, ACE inhibitors or ARBs – 68,6%, aspirin – 69,8%, calcium antagonist – 19,8%, dual antiplatelet therapy – 5,8%, long-acting nitrates – 47,7%. Molsidomine, nicorandil, ranolazine or combined lipid-lower therapy were not prescribed to anyone. After analyzing patients medication compliance it was found that 60,5% patients took statins regularly, 50% - beta-blockers, 45,3% - ACE inhibitors or ARBs, 64% - aspirin, 22% - long-acting nitrates, 2% - calcium antagonist, 46% - aspirin, 5,8% – dual  antiplatelet therapy, 8,1% - calcium antagonist, 41,9% - nitrates.  The target levels of BP, LDL-C, total cholesterol, glycemia were achieved in 65%, 20%, 30%, 40% patients.

Conclusion. There is evidence of nonoptimal drug therapy and inadequate cardiovascular risk factor modification in elderly and senile patients on ambulatory care before hospitalization for myocardial revascularization: aspirin, statins, beta-blockers, ACE inhibitors or ARBs had not been prescribed to 30% patients, all opportunities of anti-anginal therapy had not been used; less than half of patients had reached the target levels of BP, only a third of patients - the target level of LDL-C and glycemia. At the same time there is a sufficiently high patient adherence to prescribed medications treatment. The obtained data can be used to improve the preparation of elderly and senile patients for myocardial revascularization with the object to increase the effectiveness and safety of surgery and intervention procedures.

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