Analysis of the compliance of the prescribed therapy with the EURO FORTA system in polymorbidic patients of elderly and old age with CHF

Aim      To study the consistency of the prescribed therapy with the EURO FORTA (2018) system in polymorbid patients with chronic heart failure (CHF) according to data of the local registry.

Material and methods  The study included 313 patients with CHF aged 75±8.2 years. The Charlson Comorbidity Index (CCI) and the number of diseases (1–2, 3–5, >5) were calculated for all patients. Inpatient and outpatient treatment was assessed according to the EURO FORTA (2018) system based on polymorbidity degree, age, gender, and CHF type and severity.

Results For the retrospective analysis of outpatient treatment, 5 groups of patients were isolated based on the drug class in the EURO FORTA system: group 1, patients treated only with class A drugs (3.51 %); group 2, class A and B drugs (22.36 %); group 3, class A, B, and C drugs (17.25 %); group 4, class A, B, C, and D drugs 10.86 % (А, В, С, D) and 16.31 % (А, В, D); and group 5, patients without an outpatient drug therapy (29.71 %). For the analysis of inpatient treatment, 4 groups of patients were isolated based on the drug class in the EURO FORTA system: group 1, patients treated only with class A drugs (0.32 %); group 2, class A and B drugs (15.97 %); group 3, class A, B, and C drugs (57.19 %); and group 4, separately analyzed patients treated with class C and D drugs or only D in combination with class A and B drugs. Thus, 28.11 % of patients at the outpatient stage and 82.75 % of patients at the inpatient stage received drugs with questionable efficacy/safety profiles (class C); 27.17 % of patients at the outpatient stage and 26.52 % at the inpatient stage received potentially inappropriate drugs (class D). At the outpatient stage in groups 2-4, most of patients (51.43–70.59 %) had >5 diseases (pmg=0.020). At the inpatient stage, there were no significant differences between groups in the number of diseases (pmg=0.349). The groups were comparable in the left ventricular ejection fraction depending on the CHF type (pmg=0.027 and pmg=0.778) at both stages of treatment. For instance, the same patient with preserved left ventricular ejection fraction could be included into EURO FORTA group 2 for the analysis of outpatient treatment while after prescription of the inpatient treatment, he/she could be included into group 3; pmg (intergroup, detecting differences for comparison of 3 groups) exceeded 0.017; therefore, the groups were comparable in the number of CHF patients with reduced, mid-range, and preserved left ventricular ejection fraction.

Conclusion      Every second patient of the study had more than 5 diseases. Every third patient did not take any drugs at the outpatient stage. 28.11 % of patients received EURO FORTA class C drugs and 27.17% of patients received class D drugs at the outpatient stage. The drugs to be avoided in CHF, included primarily nonsteroid anti-inflammatory drugs (NSAIDs) and class I and III anti-arrhythmic medications (except for amiodarone). At the inpatient stage, 82.75 % of patients received EURO FORTA class C drugs and 26.52 % of patients received class D drugs. NSAIDs and ciprofloxacin prevailed among the drugs to be avoided in CHF.

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