Antithrombotic therapy in multimorbid patients with atrial fibrillation from standpoint of clinical recommendations of Ministry of Health of Russian Federation (2020). Effectiveness and safety of apixaban in patients with atrial fibrillation and concomitant diseases

2021 ◽  
Vol 1 (11) ◽  
pp. 12-19
Author(s):  
O. D. Ostroumova ◽  
V. N. Butorov ◽  
N. A. Arablinsky ◽  
R. R. Romanovsky ◽  
S. V. Batyukina

Clinical practice and ongoing scientific research in recent years show the importance of the problem of multimorbidity in atrial fibrillation (AF). The prevalence of AF in the general population is 1–2%, while the frequency of its occurrence increases with age – from less than 0.5% at the age of 40–50 to 5–15% at the age of 80. Only 19.6% of patients with AF have no comorbidities, 69.3% of patients have 1 to 3 comorbidities, and 11.1% of patients with AF had 4 and more comorbidities. In patients with AF and with 4 and more comorbidities, the risk of death from all causes is almost seven times higher than in patients without comorbidities. As shown by the post hoc analysis of the ARISTOTLE study, apixaban was equally effective and safe in both patients without concomitant pathology and in muliborbid patients. The efficacy and safety of apixaban has been shown in AF and concomitant arterial hypertension, heart failure, coronary heart disease, including in patients with acute coronary syndrome, diabetes mellitus, chronic kidney disease and chronic obstructive pulmonary disease. The data of scientific research in recent years are reflected in the recommendations of the Ministry of Health of the Russian Federation on AF (2020), which presents a separate section on the management of patients with concomitant diseases. It is emphasized that apixaban has shown its superiority over warfarin and other direct oral anticoagulants in terms of efficacy and safety, both in isolated AF and in patients with concomitant diseases, which makes its choice preferable in the treatment of multimirbidity AF patients.

Author(s):  
Andrei Georgievich Maliavin ◽  
Alana Viktorovna Dzanaeva ◽  
Maria Vladimirovna Avxentyeva ◽  
Sergei Lvovich Babak

Purpose of the study. Healthcare budget impact analysis in the Russian Federation of providing adult patients with chronic obstructive pulmonary disease (COPD) with basic therapy for outpatient treatment. Material and methods. The hypothesis of reducing costs for the treatment of exacerbations of COPD was tested while providing all patients with basic therapy on an outpatient basis. The model calculates the direct medical costs of drug provision and treatment of exacerbations in patients with COPD in the current situation and when all patients with COPD are covered with basic therapy as part of a program of preferential drug provision. The simulation period is 1 year. The analysis does not take into account social losses associated with disability, payment of disability certificates, reduced labor productivity and mortality. Results. The cost of providing all patients with COPD with the recommended basic drug therapy on an outpatient basis is substantially offset by a decrease in the cost of treating exacerbations: drug costs should increase by 14.1 billion rubles compared with the current situation, while the cost of providing medical care to patients with exacerbations is reduced by 9.7 billion rubles. As a result, the difference in direct medical costs, or the necessary additional investments, is 4.4 billion rubles. The price of drugs used for basic therapy has the greatest impact on the size of the required additional investments. Conclusion. Providing all patients with COPD with the recommended basic drug therapy on an outpatient basis, we can expect a decrease in the number of moderate exacerbations per year by 14.7% and severe exacerbations by 31.2%. Taking into account not only medical, but also socio-economic costs can not only offset additional investments, but also demonstrate significant savings. When implementing a pilot project of preferential drug provision for patients with COPD in a specific region of the Russian Federation, it is possible to reduce the cost of purchasing medicines when forming a municipal order.


Respiration ◽  
2021 ◽  
Vol 100 (4) ◽  
pp. 291-297
Author(s):  
Ilaria Baiardini ◽  
Marco Contoli ◽  
Angelo Guido Corsico ◽  
Carla Scognamillo ◽  
Fabio Ferri ◽  
...  

Background: Disease awareness is a challenge in the management of chronic obstructive pulmonary disease (COPD). Objectives: The aim of this analysis was to explore the association between COPD optimal and suboptimal awareness, clinical parameters, and the following patient-reported outcomes: modified Medical Research Council (mMRC), Treatment Satisfaction Questionnaire (TSQM-9), COPD Assessment Test (CAT), Morisky Medication-Taking Adherence Scale (MMAS-4), and Brief Illness Perception Questionnaire (B-IPQ). Methods: This post hoc analysis of the SAT study included all enrolled patients for whom awareness (Disease Awareness in COPD Questionnaire – DACQ) was assessed at baseline and 12 months. DACQ scores ≥80 were considered an indicator of an optimal awareness. Results: 367 patients (25.8% women, median age 72 years) were included in the analysis. At enrollment, 74 patients (20.2%) had a DACQ score ≥80. Patients with suboptimal awareness, compared to those in which awareness was optimal, had higher median scores for CAT (p = 0.0001) and mMRC (p = 0.0031), a lower median TSQM-9 global score (p < 0.0001), and higher median B-IPQ score (p < 0.0001). The proportion of patients who had exacerbations during the previous year was higher in patients with suboptimal COPD awareness than in those with DACQ score ≥80 (42.8 vs. 21.4%, p = 0.0009). During the 12-month observation period, illness perception, adherence, and treatment satisfaction were found to be independent factors significantly associated with level of disease awareness. Conclusion: The results of our post hoc analysis suggest that patients’ awareness of their COPD disease is related to both clinical outcomes and how they perceive and manage their condition.


Author(s):  
Eric Monterrubio-Flores ◽  
María D Ramírez-Villalobos ◽  
Juan Espinosa-Montero ◽  
Bernardo Hernandez ◽  
Simón Barquera ◽  
...  

Abstract Background People with a previous diagnosis of non-communicable diseases (NCDs) are more likely to develop serious forms of COVID-19 or die. Mexico is the country with the fourth highest fatality rate from SARS-Cov-2, with high mortality in younger adults. Objectives To describe and characterize the association of NCDs with the case-fatality rate (CFR) adjusted by age and sex in Mexican adults with a positive diagnosis for SARS-Cov-2. Methods We studied Mexican adults aged ≥20 years who tested positive for SARS-Cov-2 during the period from 28 February to 31 July 2020. The CFR was calculated and associations with history of NCDs (number of diseases and combinations), severity indicators and type of institution that treated the patient were explored. The relative risk (RR) of death was estimated using Poisson models and CFR was adjusted using logistic models. Results We analysed 406 966 SARS-Cov-2-positive adults. The CFR was 11.2% (13.7% in men and 8.4% in women). The CFR was positively associated with age and number of NCDs (p trend &lt;0.001). The number of NCDs increased the risk of death in younger adults when they presented three or more NCDs compared with those who did not have any NCDs [RR, 46.6; 95% confidence interval (CI), 28.2, 76.9 for women; RR, 16.5; 95% CI, 9.9, 27.3 for men]. Lastly, there was great heterogeneity in the CFR by institution, from 4.6% in private institutions to 18.9% in public institutions. Conclusion In younger adults, higher CFRs were associated with the total number of NCDs and some combinations of type 2 diabetes, chronic kidney disease, chronic obstructive pulmonary disease and cardiovascular disease.


Author(s):  
Rodríguez Miguel ◽  
◽  
Chinta Siddharth ◽  
Vittorio Timothy ◽  
◽  
...  

Background: New advances have been made in medicine, but the incidence and prevalence of Chronic Obstructive Pulmonary Disease (COPD) are evident, and it is established as the fourth cause of death in the United States representing a high cost for the healthcare system. This condition has been related to atrial fibrillation due to the changes in the lungs and vasculature. Based on this history, we seek to evaluate the outcome of AF in the patients with COPD and its relationship with medical therapy utilized to treat this pulmonary condition with the objective of establishing the relationship between the use of beta-agonist therapy for obstructive airway disease in patients with AF. Discussion: Cell receptors participate in multiple reactions and the sympathetic response is received via the alpha- and beta-receptors are related to the hemodynamic of the vasculature of the lungs and cardiovascular system. The beta-blockade agents are one of the most common medication classes used for rate control in cardiac arrhythmias, but the side effect could be COPD exacerbation; on the other hand, beta-adrenergic or beta-agonist as a therapy for this pulmonary condition could increase the heart rate leading to AF decompensation. There is a clear dilemma in our patients who have airway disease and AF since the treatment for one might worsen the other. The clear benefit in morbidity and mortality of beta-blocker therapy, especially beta1-selective, outweighs the potential for any pulmonary side-effects related to ex-acerbation of COPD or airway disease. Conclusion: There is clear data showing the evidence of the potential paradoxical side-effect between COPD and AF therapies, given the exacerbation of one due to treatment of the other, benefits versus risks should be discussed and the medical decision should be made based on them. The deteriorated cardiac condition can rapidly predispose to critical complications leading to death, which is why the use of beta-blockade agents will be chosen over possible complications with pulmonary disease. In other words, the benefit should outweigh the risk based on the best outcome for the patient. Keywords: atrial fibrillation; pulmonary disease; obstructive pulmonary disease; chronic obstructive pulmonary disease (COPD); B-Agonist; B-Block (selective; non-selective); digitalis; other antiarrhythmic.


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