THE INFLUENCE OF ADHERENCE TO TREATMENT ON MYOCARDIAL DYSFUNCTION IN ELDERLY AND SENILE PATIENTS WITH ISCHEMIC HEART DISEASE AND HEART FAILURE

The aim of the study was to study the influence of adherence to treatment on myocardial dysfunction in elderly and senile patients with ischemic heart disease (IHD) and chronic heart failure (CHF).

Material and methods. The study included 86 patients with ischemic heart disease (CHD) of older age groups admitted to  hospital treatment because of the progression of CHF: 21 patients — 65 to 74 years, 65 patients — 75 to 89 years. A standard clinical  study, echocardiography with global longitudinal strain assessment (GLS), and a Morisky-Green test were performed.

Results. It is established that in the group of persons of senile age  there is a lower adherence to treatment and more pronounced  structural and functional changes in the myocardium. The following  correlations were revealed: total score of the Morisky-Green test  with the left ventricular end-diastolic volume (r = -0.33, p <0.05), with the E/e’ (r = -0.37, p <0.05), with GLS (r = 0.53).

Conclusion. The findings indicate a lower adherence of the senile patients on treatment of IHD and CHF in comparison with the  elderly. Low adherence to therapy, as well as postinfarction  cardiosclerosis, can apparently be considered as one of the factors contributing to the progression of myocardial dysfunction.

1. Жиленко О.М., Кукенгемер В.С., Нейфельд М.С., Скирденко Ю.П. Приверженность к лечению у больных хронической сердечной недостаточностью. Научное обозрение. Медицинские науки. 2017. 5: 37-40. Zhilenko O.M., Kukengemer V.S., Neufeld M.S., Skirdenko Yu.P. Adherence to treatment in patients with chronic heart failure. Scientific review. Medical sciences.2017. 5: 37-40. [in Russian]

2. Ларина В.Н., Барт Б.Я., Головко М.Г. и др. Факторы, негативно влияющие на течение и прогноз хронической сердечной недостаточности в пожилом возрасте. Вестник Российского государственного медицинского университета. 2012; 5: 10-14. Larina V.N., Bart B.YA., Golovko M.G. et al. Factors that adversely affect the course and prognosis of chronic heart failure in old age. Bulletin of the Russian State Medical University. 2012; 5: 10- 14 [in Russian].

3. Мареев В.Ю., Агеев Ф.Т., Арутюнов Г.П. и др. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Журнал сердечная недостаточность. 2013; 14 (7): 379-472. Mareev V.Yu., Ageev F.T., Arutyunov G.P. et al. National recommendations of Society of specialists in heart failure, Russian Cardiology Society and Russian National Society of Therapists on diagnosis and treatment of CHF (fourth revision). Journal of heart failure. 2013; 14 (7): 379-472 [in Russian].

4. Митрофанова И.С., Коц Я.И., Вдовенко Л.Г. Новые пути повышения эффективности лечения больных хронической сердечной недостаточностью. Журнал сердечная недостаточность. 2016; 9 (4): 164-166. Mitrofanova I.S., Koc YA.I., Vdovenko L.G. New ways to improve the effectiveness of treatment of patients with chronic heart failure. Journal of heart failure. 2016; 9 (4): 164-166 [in Russian].

5. Никифоров В.С., Никищенкова Ю.В. Современные возможности speckle tracking эхокардиографии в клинической практике. Рациональная фармакотерапия в кардиологии. 2017. 13 (2): 248-255. Nikiforov V.S., Nikishchenkova YU.V. Modern possibilities of speckle tracking echocardiography in clinical practice. Rational pharmacotherapy in cardiology. 2017. 13 (2): 248-255 [in Russian].

6. Никифоров В.С., Свистов А.С. Продольная функция и ремоделирование миокарда у больных с постинфарктным кардиосклерозом и влияние на них ингибиторов ангиотензинпревращающего фермента. Кардиология СНГ. 2004. 2 (2): 114-121. Nikiforov V.S., Svistov A.S. Longitudinal function and remodeling of the myocardium in patients with postinfarction cardiosclerosis and the effect of inhibitors of the angiotensin- converting enzyme on them. Cardiology of the CIS. 2004. 2 (2): 114-121 [in Russian].

7. Темникова Е.А., Нечаева Г.И. Приверженность к терапии пациентов старческого возраста, страдающих хронической сердечной недостаточностью. Сибирский медицинский журнал. 2012. 27 (1): 156-160. Temnikova E.A., Nechaeva G.I. Adherence to the therapy of patients of senile age, suffering from chronic heart failure. Siberian Medical Journal. 2012. 27 (1): 156-160 [in Russian].

8. Фесенко Э.В., Коновалов Я.С., Аксенов Д.В., Перелыгин К.В. Современные проблемы обеспечения приверженности пациентов пожилого возраста с сердечно-сосудистой патологией к фармакотерапии. Научные ведомости Белгородского государственного университета. Серия: Медицина. Фармация. 2011; 16/1 (22): 95-99. Fesenko E.V., Konovalov Ya.S., Aksenov D.V., Perelygin K.V. Modern problems of ensuring adherence of elderly patients with cardiovascular pathology to pharmacotherapy. Scientific bulletins of the Belgorod State University. Series: Medicine. Pharmacy. 2011; 16/1 (22): 95-99 [in Russian].

9. Harkness K. The older patient with heart failure: high risk for frailty and cognitive impairment. Expert Review of Cardiovascular Therapy. 2012; 10 (6): 779-795.

10. Ho Р., Bryson С., Rumsfeld J. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009; 119: 3028-3035.

11. Morisky D.E., Green L.W., Levine D.M. Concurrent and predictive validity of a self- reported measure of medication adherence. Med. Care. 1986; 24 (1): 67-74.

12. Oosterom-Calo R., van Ballegooijen A.J., Terwee C.B. et al. Determinants of adherence to heart failure medication: a systematic literature review. Heart Fail. Rev. 2013; 18 (4): 409-27.

13. Osterberg L., Blaschke T. Adherence to medication. N. Engl. J. Med. 2005; 353: 487-497.

14. World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: WHO; 2003. URL: http://www.who.int/chp/knowledge/publications/adherence_report/en/