FEATURES OF USE AND EFFECTIVENESS OF THE MAIN CLASSES OF DRUGS FOR THE TREATMENT OF CHD IN ELDERLY PEOPLE

Abstract

The high mortality and poor quality of life of patients led to the need to actively search for combinations of drugs that would reduce the likelihood of complications and improve the prognosis of cardiovascular disease.

Тhe aim – was features of use and effectiveness of the main classes of drugs for the treatment of coronary heart disease in people of older age groups.

Material and Methods. We analyzed 220 case histories of patients aged 60–90 years, with coronary heart disease who were on inpatient and outpatient treatment in the Cardiology Department of D. Chebotariov Istitute of Gerontology in the period from 1997–2003 and 2015–2017. The frequency of application of certain classes of drugs at these stages of observation, the frequency of prescribing various treatment regimens and their effect on the life expectancy of elderly people with coronary heart disease was determined. At the second stage of the work, an analysis of case histories of 488 patients observed from 1997–2017 was also carried out, depending on the presence of MI in history. According to the initial observation point, the date of the first hospitalization in the cardiology department was selected. All examined patients were hospitalized for the first time in the hospital and were subsequently followed up with the main diagnosis of coronary artery disease: stable angina pectoris l-III FC, CH 0-II B. The final observation points were the last hospitalization at the time of 2017 or the patient's death. The patient’s death was chosen as the endpoint, based on which the life expectancy indicator (which was determined by the year/age of death) or age at the time of 2017 was studied.

Results and Discussion. It was shown that in 1997–2003, the most commonly prescribed groups were: β-blockers (57.2 %), ACE inhibitors (75.2 %), ASA (73.7 %), statins 60.1 % and preparations of the nitroglycerin series (31.0 %). 10.67 %, BKK-26.2 % were intended for Sartan. In 2015–2017, drugs from the group of HMG-CoA reductase inhibitors, according to the analysis, began to be prescribed in 81.1 % of cases. Nitroglycerin remedies were used much less – 17.9 %. The prevalence of prescribing antihypertensive drugs has increased: β-blockers (80.3 %), calcium channel blockers (58.9 %), angiotensin II receptor inhibitors (35.0 %). Acetylsalicylic acid was intended in 83.7 % of cases. An analysis of the therapy of patients who underwent MI indicates an inadequate prescription of drugs of the main classes of ASA received 76.2 %, statins 66.4 %, beta blockers 73.7 %, ACE inhibitors 69.0 %. As a result of the application of logistic regression, we built equations according to which the probability of developing a heart attack can be predicted depending on which drugs are used to treat the patient, and according to our model, the therapy of patients can be modified and the likelihood of developing MI can be reduced.

Conclusions. The results obtained indicate that the most effective treatment combinations for people with coronary heart disease affecting life expectancy were in patients taking ASA, statins and beta blockers – (81.4±3.16) years, ASA, statins and ACE inhibitors – 80, (1±1.71) years old.