Novel approaches to the comprehensive assessment of the quality and adherence to pharmacotherapy and its use in cardiovascular patients

Abstract

Aim. To assess quality and adherence to pharmacotherapy (PT) based on the developed integrated indicators in a cohort of outpatients with stable exertional angina.Material and methods. Using the expert evaluation method for main parameters of quality and compliance to PT, formulas were developed for calculating integrated indicators — the quality factor of PT (QFPT) and the rational PT index (RPTI). QFPT and RPTI are measured as a percentage; if the value is less than 50%, the parameters determined by them are considered unsatisfactory. In a cohort of 590 patients with stable exertional angina (men, 55,8%; mean age, 65,1±9,6 years), QFPT and RPTI were calculated. To assess the quality parameters of PT, data from patient registration forms were used, while adherence was determined using a 4-question validated score. After 21-month follow-up, primary composite endpoint was assessed: all-cause death, cardiovascular evens; an analysis of adverse outcomes was performed depending on QFPT and RPTI values.Results. In patients with exertional angina, QFPT of 0% was determined in 8 (1,4%) people, while every sixth patient (16,4%) received unsatisfactory PT (QFPT <50%). In the majority of patients (419 (82,4%) people), RPTI was less than 50%. In subgroups of patients with RPTI <50% and >50%, there was a significant difference in the Kaplan-Meier survival curves, according to the log-rank test (p=0,006). The hazard ratio (RR) in the Cox regression model showed a threefold significant increase in the risk of adverse outcomes with RPTI <50%: HR=3,0, 95% confidence interval (1,14; 7,92), p=0,026.Conclusion. The developed QFPT and RPTI make it possible to assess the quality of PT and performing a comprehensive assessment of the quality and adherence to PT, respectively. A relationship between low RPTI and a threefold increase in the risk of adverse outcomes in patients with stable exertional angina was revealed.