B-Адреноблокаторы: нереализованность задач или неготовность врачей в Российской Федерации к оптимизации лечения?

Abstract

The purpose of the study. The achievedheart rate of 50-60 beats per minute in patients after acute myocardial infarction, and up to50-70 beats per minute for patients with stable angina is considered effective. Assuming that in Russia low doses of β-blockers are often used, thequestion was raised: «How common tachycardia can bein patients with coronary heart disease (CHD) and chronic heart failure (CHF), and whether there are strategic approaches to achieving the targets in heart rate in these patients in real clinical practice and are β-blockers often used in patients for whom this group of drugs is the basic one?»Materials and Methods. Work carried out in the framework of the Russian epidemiological study of a representative sample of the European partof the Russian Federation. All patients with CHF and coronary artery disease were divided into two subgroups: heart rate reducers not receiving medicines and receiving at least one heart rate reducing drug (a β-blocker, calcium channel 1 and 3rd type (AK) blockers, glycosides).Results and discussion. In a representative sample of the program in healthy individuals (without clinical manifestations of coronary arterydisease) tachycardia was diagnosed in 7,1% of cases. Almost all respondents without CHD (87,3%) had normal heart rate from 61 to 80 beats per minute. Number of respondents without CHD with heart rate of 70 to 79 bpm. per min. (54,1%) turned out to be significantly less than that of patients with rhythm in any form of coronary artery disease (p<0,001).In a population of patients with CHF a clinical symptom of tachycardia was established in 73,5% of patients.Analysis of the prescribed β-blockers therapy in patients with CHF showed that in 54% of cases the use of beta-blockers did not result in effectivecontrol of the rhythm in patients with CHF. β-Blockers recommended for the treatment of CHF were used only 36,2% of patients.Conclusions. Early intravenous β-blockers (drug Betalok) use before percutaneous coronary intervention reduces infarct size and increases leftventricular ejection fraction in patients with myocardial infarction of ST segment elevation. Answering the question posed in the title, you can say: doctors are not ready to take an active position in prescribing and achievingthe target doses of β-blockers. This situation immediately generates the lack of task implementation in terms of optimization of therapy and reduces the risk of cardiovascular mortality in coronary artery disease and heart failure.