Critical aspects of the management of stable coronary artery disease in primary care practice or how to increase the efficacy of evidence-based pharmacological therapy?

Abstract

Introduction: The publication describes a fragment of the pharmacoepidemiologic study conducted to review the quality of management of patients with stable coronary artery disease (SCAD) in primary care over a 12-year period. The aim of the study was to justify the application of standard operating procedures (SOPs). Such determinants of pharmacotherapy as non-pharmacological modification of cardiovascular risk factors (RFs) and medication adherence were analyzed.

Material and methods: A retrospective, cross-sectional, 3-stage (2006, 2011, 2018) study was conducted in a primary care setting of Moscow. As many as 3027, 1834, 805 patients with verified diagnosis of SCAD were included. De­mographics, medical history, data on modifiable RFs and prescribed drug therapies were collected. At the third stage, medication adherence was measured, using the 8-item Morisky scale.

Results and discussion: Over a 7-year period, better control of modifiable RFs in coronary patients was revealed. The target levels of blood pressure were reached in 58.3% (+20.7%; p < 0.05) of the patients, total cholesterol – in 33.0% (+16.0%; p < 0.05), and low-density lipoprotein cholesterol – in 23.3% (+12.2%; p < 0.05). Two critical problems that determined still inadequate RFs control were identified. The attention of physicians to RFs and rates of non-pharma­cological interventions remained low throughout the study. Information on lifestyle RFs was recorded in fewer than one-third of the subjects. The lipid profile was registered only in half of patients’ histories. Non-adherence to pharma­cotherapy was identified in 51.3% of patients.

Conclusion: Further increase in efficacy of pharmacotherapy might be provided by application of SOPs regarding the registration and correction of modifiable cardiovascular RFs, identification of non-adherent patients and promotion of medication adherence.