İskemik Kalp Yetersizliği Hastalarında Klinik Kılavuz Önerilerine Uyumun Değerlendirilmesi

Abstract

Giriş: Kalp yetersizliği (KY) önemli bir sağlık sorunu olup artmış mortalite, morbidite ve sağlık harcamasıyla ilişkilidir. Bu çalışmada, KY hastalarında mortaliteyi azalttığı gösterilen ilaçların klinik pratikte hedef doza ulaşılma oranları ve bunu etkileyen faktörlerin araştırılması amaçlandı. Hastalar ve Yöntem: Ocak 2017-Aralık 2018 tarihleri arasında ST segment yükselmeli miyokart enfarktüsü (STYME) tanısıyla pimer perkütan koroner girişim (PPKG) yapılan ve sol ventrikül ejeksiyon fraksiyonu (SVEF) < %40 olan 480 hasta çalışmaya dahil edildi. Hastaların taburculuk ve altıncı ay vizitlerinde 2016 Avrupa Kardiyoloji Derneği Kalp Yetersizliği Tedavi Kılavuzu önerileri doğrultusunda mortaliteyi azalttığı gösterilmiş olan anjiyotensin dönüştürücü enzim inhibitörü (ACEI), anjiyotensin reseptör blokeri (ARB), betabloker (BB) ve mineralokortikoid reseptör blokeri (MRA) kullanım ve hedef doza ulaşma oranları araştırıldı. Bulgular: Taburculuk esnasında ACEI/ARB, BB ve MRA reçete edilme oranları sırasıyla %86, %89 ve %28 idi. Altıncı ay takip vizitinde hastaların ACEI-ARB, BB ve MRA kullanım oranları sırasıyla %72, %78 ve %42 olarak saptandı. Altıncı ayda ACEI/ARB, BB ve MRA için hedef doza ulaşılma oranları sırasıyla %28, %22 ve %24’tü. Renal fonksiyonlarda bozulma, hiperkalemi ve bradikardi hedef doza ulaşmada en çok karşılaşılan önleyici nedenler oldukları tespit edildi. Sonuç: KY hastalarında mortaliteyi azalttığı gösterilen ilaçların kullanımı ve hedef doza ulaşılma oranları istenilen düzeyin oldukça altındadır.

Keywords

• Kalp yetersizliği,kılavuzlar,ilaç uyumu

Experiences of a University Hospital on Adhering to ESC Guidelines in Patients with Chronic Ischaemic Heart Failure

Abstract

Introduction: Ischaemic heart failure (HF) is a common public health problem that is associated with increased mortality, morbidity and medical costs. This study aimed to investigate the percentage of patients with HF who are taking target doses of the drugs to improve the mortality rate and assess the reasons for the patients’ non-adherence to treatment guidelines during the follow-up period. Patients and Methods: Between January 2017 and December 2018, 480 patients who had been diagnosed with ST elevation myocardial infarction (STEMI) and had undergone primary percutaneous coronary intervention with a left ventricular ejection fraction (LVEF) of < 40% were enrolled in this study at our centre. The percentage of patients taking target doses of drugs that improved the mortality rate according to the 2016 European Society of Cardiology Guidelines for the treatment of HF, such as beta blockers (BB), angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and mineralocorticoid receptor antagonists (MRA) at the time of discharge and at the 6-month follow-up period was investigated. Results: Of the 480 patients, the follow-up data of 430 patients were available and the percentages of patients prescribed with ACEI/ARB, BB and MRA at discharge were 86%, 89% and 28%, respectively. At the 6-month follow-up, the percentages of patients using ACEI/ARB, BB and MRA were 72%, 78% and 42%. About 7% of patients using BB switched to a different BB and 5% of the patients using ACEI were found to switch to an ARB. The percentages of patients taking target doses of ACEI/ARB, BB and MRA were 28%, 22% and 24%, respectively. Metoprolol succinate, ramipril and spironolactone were the most prescribed agents. Worsening of renal function, hyperkalaemia and bradycardia were the main reasons for non-achievement of target doses during the follow-up period. Conclusion: In clinical practice, the percentage of patients with ischaemic HF who were receiving optimal target doses of BB, ACEI and MRA was far below the desired levels as compared to the European Society of Cardiology (ESC) guidelines.

Keywords

• Guidelines,heart failure,medication adherence

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