Assessment of patients' attendance at outpatient clinics and prehospital therapy: Russian acute coronary syndrome registry LISS-3 data

摘要

Attendance prior to ACS was generally higher in patients with established CVD and in patients with evident risk factors. The overall quality of prehospital therapy was better in patients with higher attendance rate, however, even in attendants it was far from that recommended by current clinical guidelines. Objective: Despite greater use of modern medication therapy, effective reperfusion therapy and primary percutaneous coronary interventions, mortality following acute coronary syndrome (ACS) remains substantial [1,2]. Prehospital therapy is one of the components that influences outcomes of a disease [3]. Its quality may depend on different factors: quality of identification of high risk patients, physicians' adherence to use of clinical guidelines in their practice, patients' adherence to doctors' recommendations [4]. The aim of the present study was to analyze patients' attendance at outpatient clinics (OC) prior to the development of ACS and its influence on the quality of their prehospital therapy. Methods: For this part of the study (from November 1, 2013 to July 31, 2015) we used the data of the LISS-3 (Lyubertsy Infarct Survival Study) hospital registry. All survived patients hospitalized with ACS (n=320) were asked to fill out the questionnaire about regularity of attendance at OC prior to ACS, medical history and prehospital therapy taken for at least 2 months before hospitalization. Patients were divided into three groups depending on their rate of attendance: attendants-patients, who visited a primary care physician or cardiologist at OC once a year or more often (n=139); patients with partial attendance-those, who visited their primary care physician less than once a year, visited their doctor irregularly (n=103); non-attendants-those, who had never visited a primary care doctor prior to ACS (n=78). Results: Table 1 compares general characteristics of the 3 groups of patients. Higher rate of attendance was positively associated with gender (female), elder age, higher education level, history of cardiovascular disease (CVD) and main cardiovascular risk factors. Smoking and employment status were associated with lower rate of attendance. Few patients in all groups told about the presence of hyperlipidemia, however, blood tests performed in hospital showed that most of patients had increased cholesterol level. Patients with ischemic heart disease (IHD) were generally more compliant with attendance at OC, however, a large group of patients with history of IHD had low attendance rate prior to ACS. Although the use of medications with proven positive influence on CVD outcomes increased with the increase of attendance rate, the use of statins, antiplatelets, @b-blockers, antihypertensive drugs was insufficient even in attendants. On the other hand, patients of the 3 groups didn't differ by the use of diuretics, nitrates, calcium antagonists, antiarrhythmic drugs. Conclusions: Our study shows that attendance prior to ACS was generally higher in patients with established CVD and in patients with evident risk factors, except smoking. A lot of patients were unaware of hyperlipidemia, even those with high attendance rate. The overall quality of prehospital therapy was better in patients with higher attendance rate, however, even in attendants the quality of primary and secondary medical prevention was far from that recommended by current clinical guidelines.