Research on adherence of elder patients with cardiovascular diseases to surgical treatment and assessment of the endovascular treatment clinical efficacy

Abstract

Background. Patients with cardiovascular diseases (CVD) older than 70 years have low adherence to surgical treatment. Aim. To investigate the adherence of elder patients with CVD to surgical treatment and evaluate the effectiveness of endovascular care. Material and methods. In 20162020 on the basis of the vascular surgery department of the Central Clinical Hospital Russian Railways-Medicine (Moscow) and the Peoples' Friendship University of Russia standardized clinical interviewing of patients with surgical CVD (n=422, average age 76.117.2 years) was conducted. Patients were considered adherent to surgical treatment if more than in 90% of cases they agreed to undergo cardiovascular surgery. Endovascular operations were performed (100%). Evaluation of the endovascular treatment effectiveness was carried out according to the following criteria: reducing the degree of ischemia, the duration of hospital treatment, the frequency of hospitalizations during the year caused by the CVD progression, and two-year survival. The duration of patients supervision was 24 months. We compared the results of the years 20162017 (the period of mainly conservative treatment, group A, n=106) and the years 20182019 (the period of high surgical activity for CVD, group B, n=422 which included 106 patients from group A). Differences between the compared indicators were considered significant at p 0.05. Results. The adherence of patients over 70 years old to surgical CVD treatment was 99.5% if endovascular technology was suggested. The priority usage of endovascular care contributed to the growth of surgical activity in the vascular surgery department from 7 to 98.9% (p=0.0015), as well as high immediate and long-term (24 months) clinical efficiency (100 and 88%), and two-year survival of patients up to 100% (group B). The average duration of hospitalization for endovascular treatment was 5.10.11 days, for conservative treatment it was 8.43.6 days (p=0.02). The average number of hospitalizations per year for patients in group A was 3.1 times, in group B 1.6 times (p=0.0028). Conclusion. Endovascular care for CVD curing is an effective method of surgical treatment and promotes adherence of elder patients to surgical treatment.