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.
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