Research on adherence of elder patients with cardiovascular diseases to surgical treatment and assessment of the endovascular treatment clinical efficacy

Abstract

Background. Patients with cardiovascular diseases (CVD) older than 70 years have low adherence to surgical treatment.

Aim. To investigate the adherence of elder patients with CVD to surgical treatment and evaluate the effectiveness of endovascular care.

Material and methods. In 2016–2020 on the basis of the vascular surgery department of the Central Clinical Hospital “Russian Railways-Medicine” (Moscow) and the Peoples' Friendship University of Russia standardized clinical interviewing of patients with surgical CVD (n=422, average age 76.11±7.2 years) was conducted. Patients were considered adherent to surgical treatment if more than in 90% of cases they agreed to undergo cardiovascular surgery. Endovascular operations were performed (100%). Evaluation of the endovascular treatment effectiveness was carried out according to the following criteria: reducing the degree of ischemia, the duration of hospital treatment, the frequency of hospitalizations during the year caused by the CVD progression, and two-year survival. The duration of patients’ supervision was 24 months. We compared the results of the years 2016–2017 (the period of mainly conservative treatment, group A, n=106) and the years 2018–2019 (the period of high surgical activity for CVD, group B, n=422 which included 106 patients from group A). Differences between the compared indicators were considered significant at p <0.05.

Results. The adherence of patients over 70 years old to surgical CVD treatment was 99.5% if endovascular techno­logy was suggested. The priority usage of endovascular care contributed to the growth of surgical activity in the vascular surgery department from 7 to 98.9% (p=0.0015), as well as high immediate and long-term (24 months) clinical efficiency (100 and 88%), and two-year survival of patients up to 100% (group B). The average duration of hospita­lization for endovascular treatment was 5.1±0.11 days, for conservative treatment it was 8.4±3.6 days (p=0.02). The average number of hospitalizations per year for patients in group A was 3.1 times, in group B — 1.6 times (p=0.0028).

Conclusion. Endovascular care for CVD curing is an effective method of surgical treatment and promotes adherence of elder patients to surgical treatment.

Keywords

adherence / efficacy / elder patients / cardiovascular disease / surgery / endovascular care

References

[1] Smith S, Collins A, Ferrari R, Holmes D, Logstrup S, McGhie D. Our time: a call to save preventable death from cardiovascular disease (heart disease and stroke). Global Heart. 2012;7:297–305. DOI: 10.1016/j.gheart.2012.08.002.

[2] De Rosa R, Palmerini T, De Servi S, Belmonte M, Crimi G, Cornara S. High on-treatment platelet reactivity and outcome in elderly with non ST-segment elevation acute coronary syndrome — Insight from the GEPRESS study. Int J Cardiol. 2018;259:20–25. DOI: 10.1016/j.ijcard.2018.01.057.

[3] Shmid T, Roux L, Pratt M. Globalization and urbanization: implications for promotion of physical activity. Profilakticheskaya meditsina. 2014;17(1):18–21.

[4] Shmid T, Roux L, Pratt M. Глобализация и урбанизация: последствия для повышения физической активности. Профилактическая медицина. 2014;17(1):18–21.

[5] Roth G, Mensah G, Johnson С, Addolorato G, Ammirati E, Baddour L, Barengo N, Beaton A, Benjamin E, Benziger C. Global burden of cardiovascular diseases and risk factors, 1990–2019: Update from the GBD 2019 study. J Am Coll Cardiol. 2020;76(25):2982–3021. DOI: 10.1016/j.jacc.2020.11.010.

[6] Goloshchapov-Aksenov R, Kicha D, Al Baqara AA. Clinical management to improve of medical care for patients with cardiovascular diseases. Bahrain Medical Bulletin. 2021;43(1):367–372.

[7] Kim D, Rich М. Patient-сentered сare of оlder аdults with сardiovascular disease and multiple chronic conditions. Can J Cardiol. 2016;32(9):1097–1107. DOI: 10.1016/j.cjca.2016.04.003.

[8] Agarkov NM, Goloshchapov-Akse­nov RS, Fomina RV, Aksenov VV, Korneeva SI. Invasive and drug therapy in geriatric patients with myocardial infarction. Tutorial. Belgorod: Epicenter; 2021. 588 р. (In Russ.)

[9] Агарков Н.М., Голощапов-Аксёнов Р.С., Фомина Р.В., Аксёнов В.В., Корнеева С.И. Инвазивная и медикаментозная терапия у гериатрических пациентов с инфарктом миокарда. Учебное пособие. Белгород: Эпицентр; 2021. 588 с.

[10] Abramov A, Goloshchapov-Aksenov R, Kicha D, Rukodaynyy O. Organizational and technological algorithm of primary specialized health care at cardiovascular diseases. Kazan Medical Journal. 2020;101(3):394–402. DOI: 10.17816/KMJ2020-394.

[11] Абрамов А.Ю., Голощапов-Аксёнов Р.С., Кича Д.И., Рукодайный О.В. Организационно-технологический алгоритм первичной специализированной медико-санитарной помощи при сердечно-сосудистых заболеваниях. Казанский медицинский журнал. 2020;101(3):394–402. DOI: 10.17816/KMJ2020-394.

[12] Gerhard-Herman M, Gornik H, Barrett C, Barshes N, Corriere M, Drachman D, Fleisher L, Fowkes F. 2016 AHA/ACC Guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. J Am Coll Cardiol. 2017;69(11):1465–1508. DOI: 10.1016/j.jacc.2016.11.008.

[13] National guidelines for the diagnosis and treatment of diseases of the arteries of the lower extremities. Moscow; 2019. 89 p. http://www.angiolsurgery.org/library/recommendations/2019/recommendations_LLA_2019.pdf (access date: 03.09.2021). (In Russ.)

[14] Национальные рекомендации по диагностике и лечению заболеваний артерий нижних конечностей. М.; 2019. 89 с. http://www.angiolsurgery.org/library/recommendations/2019/recommendations_LLA_2019.pdf (дата обращения: 03.09.2021).

[15] Roffi M, Patrono C, Collet J, Mueller C, Valgimigli M, Andreotti F, Bax J, Borger M, Brotons C, Chew D, Genser B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mihilli J, Mukherjee D, Storey R, Windecker S. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Task force for the management of acute co­ronary syndromes in patients presenting without persistent ST-segment elevation of the European society of cardiology (ESC). Eur Heart J. 2016;37(3):267–315. DOI: 10.1093/eurheartj/ehv320.

[16] Clinical guidelines. Ische­mic stroke and transient ischemic attack in adults. 2020. 206 p. https://webmed.irkutsk.ru/doc/pdf/stroke.pdf (access date: 03.09.2021). (In Russ.)

[17] Клинические рекомендации. Ишемический инсульт и транзиторная ишемическая атака у взрослых. 2020. 206 с. https://webmed.irkutsk.ru/doc/pdf/stroke.pdf (дата обращения: 03.09.2021).

[18] Abramov A, Goloshchapov-Aksenov R, Semenov V, Kicha D, Rukodaynyy O. Clinical and organizational assessment of endovascular care accessibility at the regional level. Problemy sotsialnoy gigieny, zdravookhraneniya i istorii meditsiny. 2020;28(4):596–599. 10.32687/0869-866X-2020-28-4-596-599.

[19] Rothman М, Van Ness Р, O’Leary J, Fried N. Refusal of medical and surgical interventions by older persons with advanced chronic disease. J Gen Intern Med. 2007;22(7):982–987. DOI: 10.1007/s11606-007-0222-4.

[20] Zhao Q, Xu H, Liu Q, Ye Y, Zhang B, Li Z, Gao R, Wu Y. Therapeutic decision-making and outcomes in elderly patients with severe symptomatic aortic stenosis: Prognostic implications of elderly patients' initial decisions. Front Cardiovasc Med. 2021;8:696763. DOI: 10.3389/fcvm.2021.696763.

[21] Golo­shchapov-Aksenov R, Semenov V, Kicha D. Organizational and clinical foundations of endovascular methods for the dia­gnosis and treatment of cardiovascular diseases. Moscow: MIA; 2019. 368 p. (In Russ.)

[22] Голощапов-Аксёнов Р.С., Семёнов В.Ю., Кича Д.И. Организационные и клинические основы рентгенохирургических методов диагностики и лечения сердечно-сосудистых заболеваний. М.: МИА; 2019. 368 с.

[23] Goloshchapov-Aksenov R, Kicha D, Sharapova O. Endovascular biometrics. 2020 Ural Symposium on Biomedical and Engineering, Radioelectronics and Information Technology (USBEREIT). 2020; 0051–0053. DOI: 10.1109/USBEREIT48449.2020.9117704.

[24] Jokisalo E, Enlund H, Halonen P, Takala J, Kumpusalo E. Factors related to poor control of blood pressure with antihypertensive drug therapy. Blood Press. 2003;12(1):49–55. PMID: 12699136.

[25] Krepkogorsky NV, Bulatov DG. The results of femoral-popliteal (tibial) bypass surgery by the method of “in situ” in patients with an extended lesion of the arterial bed of the lower limbs critical ischemia. Kazan Medical Journal. 2015;96(6):942–949. (In Russ.) DOI: 10.17750/KMJ2015-942.

[26] Крепкогорский Н.В., Булатов Д.Г. Результаты бедренно-подколенного (берцового) шунтирования по методике in situ у пациентов с протяжённым поражением артериального русла нижних конечностей и критической ишемией. Казанский медицинский журнал. 2015;96(6):942-949. DOI: 10.17750/KMJ2015-942.

[27] Bradbury A, Adam D, Bell J, Forbes J, Fowkes G, Gillespie I, Ruckley C, Raab G. BASIL trial participants. Bypass versus Angioplasty in Severe Ischemia of the Leg (BASIL) trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg. 2010;51(5):5S–17S. DOI: 10.1016/j.jvs.2010.01.073.

[28] Kavteladze ZA, Вylov KV, Drozdov SA. Angioplasty and stenting of the superficial femoral artery. International Journal of Interventional Сardioangiology. 2011;(24):52–53. (In Russ.)

[29] Кавтеладзе З.А., Былов К.В., Дроздов С.А. Ангиопластика и стентирование поверхностной бедренной артерии. Международный журнал интервенционной кардиоангиологии. 2011;(24):52–53.

[30] Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–497. DOI: 10.1056/NEJMra050100.

[31] Neutel J, Smith D. Improving patient compliance: a major goal in the management of hypertension. J Clin Hypertens (Greenwich). 2003;5(2):127–132. DOI: 10.1111/j.1524-6175.2003.00495.x.

[32] Fried T, Gillick M. Medical decision-making in the last six months of life: choices about limitation of care. J Am Geriatr Soc. 1994;42:303–307. DOI: 10.1111/j.1532-5415.1994.tb01756.x.

[33] Pereverzeva KG, Yaku­shin SS, Loukianov MM, Drapkina OM. Adherence to the treatment of pa-tients in the long-term supervision period after myocardial infarction (according to the ­REGATA regis­ter). Kardiologiya. 2020;60(10):66–72. (In Russ.) DOI: 10.18087/cardio.2020.10.n1264.

[34] Переверзева К.Г., Якушин С.С., Лукьянов М.М., Драпкина О.М. Приверженность лечению пациентов в отдалённом периоде наблюдения после перенесённого инфаркта миокарда (данные регистра РЕГАТА). Кардиология. 2020;60(10):66–72. DOI: 10.18087/cardio.2020.10.n1264.

[35] Katlic M. Principles of geriatric surgery. In: Rosenthal RA, Zenilman M, Katlic M. Principles and practice of geriatric surgery. New York, NY: Springer Science + Business Media; 2011. p. 235–251.

RIGHTS & PERMISSIONS

Eco-Vector