CARDIOVASCULAR COMORBIDITY IN THE REAL CLINICAL PRACTICE OF AN AMBULATORY PHYSICIAN. COMPARATIVE REGISTER RESEARCH IN THE RYAZAN REGION
Aim. To study the structure of cardiovascular comorbidities, the quality of outpatient management and the structure of concomitant pathology in patients with cardiovascular continuum. To compare the obtained results with the results of the pilot stage of the REKVAZA register study (Outpatient Polyclinic Register of Cardiovascular Diseases in the Ryazan Region), conducted in 2012 using similar selection criteria. To evaluate the results of preventive measures for this patient population. Material and methods. We carried out one-stage retrospective analysis of 1 thousand outpatient cards of cardiovascular patients in Ryazan, who visited a general practitioner in 2016. Results. The overall comorbidity of cardiovascular patients reaches 91% and elevates with age increasing. Since 2012, the frequency of various combinations of cardiovascular diseases has increased from 82% to 89,7%, but the frequency of cerebral stroke and myocardial infarction has not changed. Chronic kidney disease has been found to be significantly associated with coronary artery disease, myocardial infarction and cerebral stroke; type 2 diabetes mellitus - with coronary artery disease and obesity. All patients suffered from hypertension, but only 39,5% reached target blood pressure levels (<140/90 mm Hg) - that is 13,6% more than in 2012. Over the past 4 years, the number of people receiving statins increased from 35,9% to 50,6%, but the proportion of patients who achieved total cholesterol levels <5,0 mmol/l decreased from 51,1% to 31,6%. The frequency of prescription of antiplatelet agents and anticoagulants in the total cohort of the surveyed patients decreased from 64,8% to 40,6%. Conclusion. Comorbidity levels among cardiovascular patients are high and it increases with age; the most common are various combinations of cardiovascular diseases. Antihypertensive, antiplatelet and lipid-lowering therapy does not fully comply with current clinical guidelines. Insignificant positive changes in the management of patients were noted: compared to 2012, the number of people receiving antihypertensive therapy and the number of patients taking statins increased, but there were no positive changes in case management.