Treatment of Patients With Stable Ischemic Heart Disease in Real Clinical Practice in Russia. The CHOICE-2 Program
Objective: in the framework of an open post-marketing observational national program CHOICE-2 to assess correspondence between recommendations for management of patients with stable angina and actual clinical practice, as well as to assess effect of treatment with cytoprotector trimetazidine on clinical course of the disease. Material and methods. Participating physicians (n = 185 from 46 regions of Russian Federation) recruited 896 patients with ischemic heart disease (IHD). Checkup included registration of complaints, medical history, demographic and anthropometric data, physical examination, measurement of blood pressure (BP), heart rate (HR), respiratory rate (RR), registration of ECG, determination of functional class (FC) of angina (Canadian Cardiovascular Society classification), presence and severity of heart failure (NYHA class). Information on frequency of attacks of angina, short-action nitrates requirements, and changes of exercise tolerance was taken from patient's diaries. Visual analog scale (VAS) was used for evaluation of severity of dyspnea. Results. At initiation of the program physicians increased prescribing of the following drugs: statins (from 74 to 92%), beta-blockers (from 84 to 92.7%), ivabradine (from 4.7 to 8.8%), renin-angiotensin system inhibitors (from 85 to 95.4%), trimetazidine (from 13 to 100%). This led to a significant reduction of BP (from 147.1±14.3/88.1±9.0 to 127.4±9.0/78.4±6.5 mm Hg), HR (from 75,6±9,6 to 65.8±6.1 bpm), frequency of angina attacks (from 5.36±5.38 to 1.12±1.70 per week), nitroglycerine consumption (from 5.12±5.23 to 0.87±1.43 doses). Walk distance increased from 336.9±252.9 to 593.6±419.8 meters. There occurred 6-fold increase of number of patients with FC I angina and 4-fold decrease of number of patients with FC III angina. According to VAS well-being improved from 44.0±17.3 to 77.3±16.6 points. Frequency of requests for emergency medical care reduced from 36.4 to 19.4%, and frequency of hospitalizations fell from 25.9% during preceding 6 months to 7.3% during 6 months after therapy change. Conclusion. It is necessary to improve the adherence to recommendations on optimal medical therapy, and increase the frequency of trimetazidine use in the structure of anti-anginal therapy.