PRESCRIPTION OF MEDICATIONS INFLUENCING PROGNOSIS IN ATRIAL FIBRILLATION WITH ARTERIAL HYPERTENSION, CORONARY HEART DISEASE, CHRONIC HEART FAILURE, BY THE REGISTRY REKVAZA-CLINIC

Aim. To investigate on the prevalence of oral anticoagulation prescription (OAC), of β-blockers (BAB), angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor type II blockers (ARB), and statins in patients with atrial fibrillation (AF) comorbid with arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF) at inpatient and out-patient stages of management, under framework of REKVAZA-CLINIC registry of cardiovascular diseases (CVD).

Material and methods. Into the RECVAZA-CLINIC study, 3696 patients included, with diagnoses of AF, AH, CHD, CHF and combinations, hospitalized to NRCPM from 01.04.2013 to 31.12.2014, living in Moscow and Moscow Region. Of those, in current study 285 patients included (7,7%) with combinations of AF, AH, CHD, CHF. Prescription at outpatient stage of the OAC, BAB, ARB/ACEi and statins was assessed by case histories review. After the discharge, in 24,1±5,9 months, drug treatment was assessed by phone calls in 250 patients, and in 35,5±7,5 months — during office cardiologist visit in 113 randomly selected patients.

Results. Mean age of the patients with combination of AF, AH, CHD and CHF was 73,9±10,0 y.o. (52,6% males). Myocardial infarction (MI) in anamnesis had 58,9% patients, stroke — 21,7%. At hospital stage, and in 2 and 3 years of follow-up, the prevalence of ACEi/ARB prescription did not decrease significantly, but statins were prescribed less comparing to in-patient stage (1,5 and 2,0 times), as OAC (1,2 and 1,4 times) and BAB (1,1 times in 3 years of follow-up). Combination of 4 drugs of the included classes, was the most commonly prescribed in-patient (68%) and most rare — before admission and in 3 years of post-discharge follow-up — 3,7 and 2,3 times more rare, than in inpatient stage. Postinfarction cardiosclerosis patients were less commonly prescribed the OAC at pre-admission stage (1,4 times) and BAB before admission and in hospital (1,2 times), as 2 years later (1,1 times). The ACEi/ARB were prescribed too rare at pre-admission and post-discharge stages (1,2 and 1,1 times), OAC for the period of 3 years (1,3 times). If comparing the patients with anamnesis of stroke, and with none, there were no significant differences of the drugs prescription frequency.

Conclusion. By the data from in-hospital prospective registry RECVAZACLINIC, in patients with AF, AH, CHD, CHF at pre-admission stage, especially out-patient, the following drugs prescribed too rarely: OAC, BAB, ACEi/ARB, statins, that have beneficial impact on prognosis. It is important to increase outpatient physicians adherence to the combinations prescription for OAC, BAB, ACEi/ARB, statins in this category of patients. 

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