Evaluation of Inpatient Treatment Effectiveness of Patients with Acute Myokardial Infarction Galachenko O. О., Ocheredko O. M., Galachenko V. V.

Galachenko O. О., Ocheredko O. M., Galachenko V. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Acute coronary syndrome is leading cause of mortality and disability incidence in both adult (33,7 %) and capable (33,5 %) populations. First 20 day lethality due to acute myocardial infarction (AMI) in developed coun- tries ranges in 20 %-25 % bounds, approaching 30 %-40 % in first year. The main survival effect renders by clinical form of AMI, burden of comorbidity, in particular hypertension with systolic pressure >150 mm Hg and diastolic pressure >90 mm Hg, obesity > 25 % over weight correspondent to height. We tried to unveil and assess reserves to improve efficacy of inpatient treatment of patients hospitalized with acute myocardial infarction. Cohort of 1122 patients with accident myocardial infarction (MI) hospitalized in Vinnitsa cardiological department in 2006-2008. Clinical variables of patients were being measured. Data analysis exploited log-linear modeling. Diagnoses con- sisted of ICD-10 codes І21. 0-І21. 3, І21. 4, І21. 9, І22. The most prevalent localizations happened to be anterior (33,2 %), posterior (37,4 %), and frontolateral (12,0 %) MI. In the presence of pathological Q most frequently ob- served posterior localization (43,9 %), while in the absence it was anterior (51,9 %), c2(7) = 88,1; р < 0,0001. It ap- peared that administration of pharmacotherapy clinically substantiated and significantly depended upon severity of patient condition. The most cases confined themselves to 10-25 days of hospital staying. Age of a patient failed to proof its significance. Occupation proved to be significant moderator (F = 3,33; p = 0,036) with minimum of 17,6 days of staying in unemployed and maximum of 18,5 days in good seated. The most influential on terms of stay- ing revealed to be severity of patient’s condition (F = 16,03; p < 0,0001) with minimum of 16,8 days in patients with moderate condition and 19,6 days in severe cases. We made emphasis on pharmacotherapy because the more intensive procedures were sporadic in time of shaping cohort. Local clinical protocol included аspirin, сlopidogrel, Heparin, β­blockers, Statins, IAPF, Ca­blockers, and Nitrates. Neither patient’s occupation nor clinical character­ istics moderated continuation of administered pharmacotherapy. To ours opinion discharges were proceeded un­ timely neglecting protocol requirement to health condition at discharge so that signs of ischemia at discharge were present in 12,4 % ± 1,0 % of patients, shortness of breath in 16,7 % ± 1,1 %, edema of limbs in 4,4 % ± 0,6 %, com­ plaints on heartache in 10,0 % ± 0,9 % of patients. Severity of condition at hospitalization and age of patient were the most influential from the set to determine presence of clinical symptoms at discharge. Delivered findings are the starting momentum to study survival of patients across the schemes of pharmacotherapy, terms of staying, health conditions at discharge Drawbacks. Treatments prescribed by protocols that can differ across localities. Charlson’s comorbidity index may be inappropriate to measure expediency of medication as well as related outcomes. The cohort is still heterogeneous that relates to individual heterogeneity of treatment efficacy, e. g. different individual survival opportunities. Some other factors may influence hospital stay and compliance that are beyond the purview of given research, say motivation of physician or patient, patient’s IQ, etc. Dynamic reforms of medical care as probable as not reshape both the condition of patient at the point of hospitalization and at the point of discharge. So appropriate corrections are inevitable.

acute myocardial infarction, inpatient treatment, efficacy

• Гайдаєв Ю. О. Розробка і впровадження Державної програми профілактики та лікування серцево-судинної і судинно- мозкової патології, 2007 [Електронний ресурс] / Ю. О. Гайдаєв – Режим доступу: http://www.rql.com.ua/cardio_j/2007/4/ gaydayev.htm.
• Протокол надання медичної допомоги хворим із гострим коронарним синдромом з елевацією ST (інфарктом міокарда з зубцем Q) Додаток до наказу МОЗ № 436 від 03-07-2006 [Електронний ресурс] – Режим доступу: http://medstandart. net/browse/2202).
• Універсальне визначення інфаркту міокарда Європейського товариства кардіологів, Американського кардіологічного коледжу, Американської асоціації серця та Всесвітньої кардіологічної федерації (2007) [Електронний ресурс] – Режим доступу: http://nmu-s. net/load/terapija/ skachat /universalne_viznachennja_infarktu_miokarda/ 66-1-0-901.
• Kattainen A. Coronary heart disease: from a disease of middle-aged men in the late 1970s to a disease of elderlywomenin the 2000s. / A. Kattainen, V. Salomaa, T. Harkanen [et al.] // Eur. Heart J. – 2006. – № 27. – Р. 296-301.
• Spiegelhalter D. J. Bayesian approaches to multiple sources of evidence and uncertainty in complex cost-effectiveness mod- eling / D. J. Spiegelhalter, N. G. Best // Int. J. Technol. Assess. Health Care. – 2001. – № 17. – Р. 69-82.

«Bulletin of problems biology and medicine» Issue 3 part 2 (111), 2014 year, 118-122 pages, index UDK 614. 2: 577. 4- 02