Efficacy of Follow-up Monitoring for Patients with Very High Cardiovascular Risk in the Omsk Region

Abstract

Follow-up is the basis for the effectiveness of secondary cardiovascular prevention. Preferential drug provision is a necessary condition for the mass implementation of cardiac rehabilitation programs, as it ensures maximum adherence of patients to expensive drug therapy and the need for regular doctor’s appointment. The Omsk Region has organized and operates a patient routing system aimed at timely initiation and continuous drug provision within the framework of the Federal Project “Fight against Cardiovascular Diseases”. Aim. To evaluate the effectiveness of the first year of cardiac rehabilitation in patients with very high cardiovascular risk who received preferential drugs from the list approved by the Order of the Ministry of Health of the Russian Federation dated January 9, 2020 No. 1n. Material and methods. The study was conducted at the Omsk Region Clinical Cardiology Dispensary, a state-financed health care institution, from January 1 to December 31, 2020. A retrospective cohort study was conducted of outpatient records of patients subjected to preferential provision of medicines, namely, those who were in the dispensary for acute stroke, myocardial infarction, or for coronary artery bypass grafting, coronary artery stenting or catheter ablation. A clinical-expert analysis of 1502 final clinical reports of patients who completed follow-up after one year was carried out. The patients’ adherence to dispensary observation, achievement of the target values of the main risk factors, total one-year mortality, frequency of recurrent cardiovascular events and occurrence of adverse events, primary disability were determined. Results and discussion. Outcomes of follow-up monitoring against the background of subsidized drug coverage: total one-year mortality – 1.5% (28 patients, 65.9±6.3 years, men 72.7%). Recurrent cardiovascular events in 12 months – 249 (13.8%) patients (68.4±7.4 years, men 182 (73.1%)). 10 patients had significant atrial fibrillation paroxysms requiring hospitalization (0.6%, 59.4±5.8 years, 40.0% men). Recurrent cardiovascular events were significantly more common in men (χ2 7.45; p=0.045). Target LDL-C level of less than 1.4 mmol/L were achieved in 270 (15.0%) patients with very high cardiovascular risk. Adverse events were identified: non-fatal bleeding – 14 patients (0.8%, 73.4±7.6 years, men 57.1%), transaminitis – 14 patients (0.8%, 70.4±2.3 years, men 71.4%), myalgia on statin therapy – 21 patients (1.2%, 71.2±2.5 years, men 52.4%), dyspnea on ticagrelor – 21 patients (1.2%, 58.4±4.3 years, men 47.6%) 1432 patients (95.3%) had no specified adverse events. There was a significant increase in new cases of type 2 DM from 331 (18.3%) to 339 (22.6%; χ2 McNemar A/D 4.07; p=0.044; B/C 93.09; p=0.002). High-normal blood glucose levels were observed at baseline in 384 patients (21.3%); by the end of follow-up, the number of patients with high-normal glucose was 540 (30.0%; χ2 86.08; p=0.002). There was a significant decrease in the number of patients with CHF (from 72 (4.0%) to 45 (3.0%); χ2 McNemar A/D 48.52; p=0.000; B/C 45.14; p=0.034). Conclusion. The results obtained testify to the effectiveness of the ongoing comprehensive program of medical rehabilitation (medication, physical rehabilitation and psychological counseling).