A retrospective analysis of the quality of treatment preceding acute coronary syndrome in real outpatient practice in patients with atrial fibrillation: local register data

Aim. To study retrospectively the treatment preceding acute coronary syndrome (ACS) in patients with atrial fibrillation (AF) in real-life outpatient practice on the territory of Kirov Region. Materials and methods. The registry included 163 patients with AF who were undergoing rehabilitation following ACS (ACS occurred <1 month ago) in the hospital of Kirov State Medical University. Mean age of patients was 64.9±9.7; 55.8% were men. Results. 92.6% of patients were assigned to group 4 of cardiovascular risk (CVR). Only 26.4% of all patients received hypolipidemic therapy (HLT); only 21.9% of CVR group 4 patients, 66.7% of CVR group 3 patients, and all patients of group 2 achieved the total cholesterol goal. Only 10.6% of group 4 patients, 55.6% of group 3 patients, and 33.3% of group 2 patients achieved the LDL-C goal. Assessment of antithrombotic therapy (ATT ) in AF patients showed that 34.3% of patients received oral anticoagulants (OACs) (vitamin K antagonists (VKAs) - 30.5% and new generation OAKs (NOACs) - 3.8%); 21.5% of patients not taking VKAs monitored their international normalized ratio (MNR) on a regular basis and 9.4% of patients had a target MNR during admission; and 13.3% of patients at high risk of stroke according to the CHA₂DS₂-VASc scale had thromboembolic complications (TEC). 83.6% of patients received a therapy for IHD; 21.88% received a therapy completely consistent with clinical guidelines. 78.2% of patients received a therapy for CHF; 30.08% received a therapy completely consistent with clinical guidelines. Analysis of antihypertensive therapy (AHT) in AF patients showed that 39.3% of patients received a rational combination AHT; 34% received probably rational (considering concurrent conditions) therapy; and 0.7% received a non-rational therapy. 17.33% of AH patients achieved the BP goal; fixed-combination AHTs were administered extremely rarely (4%). Conclusion. The retrospective analysis of treatment quality in patients with AF showed that HLT, ATT, and AHT for IHD and CHF were of very low quality, which suggested that efficacy and safety control for the treatment of major cardiovascular diseases (CVD) administered to this patient cohort before ACS was virtually absent. Generally, approximately the same situation was described in similar registries of Europe, China and Russia.

ретроспективный анализ качества лечения, фибрилляция предсердий, острый коронарный синдром, регистр, retrospective analysis of treatment quality, atrial fibrillation, acute coronary syndrome, register

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