| Abstract | Kardiovaskularne bolesti (KVB) su veliki problem suvremenom čovjeku. Prema podacima Svjetske zdravstvene organizacije vodeći uzrok smrtnosti u suvremenom svijetu pa tako i u Hrvatskoj su KVB. Ishemička bolest srca koja dovodi do infarkta miokarda, ugradnje stenta (usadak) i/ili premosnice (baypass), potom cerebrovaskularni inzult te fibrilacija atrija, uzrokovani su između ostalog i čimbenicima rizika kao što su dislipidemije i šećerna bolest. Dislipidemija je u podlozi ateroskleroze, a ateroskleroza u podlozi većine KVB. Šećerna bolest (dijabetes tipa 1 i tipa 2) je praćena dislipidemijom kao čimbenikom rizika za komplikacije bolesti. Stoga je primjena hiplolipemika sastavni dio u liječenju bolesti krvožilnog sustava uzrokovanih aterosklerozom i dijabetesa.
Europsko kardiološko društvo objavilo je 2012. godine Europske smjernice za kardiovaskularnu prevenciju i primjereno propisivanje lijekova. Preporuka je da svi bolesnici nakon preboljelog infarkta miokarda i cerebrovaskularnog inzulta moraju uzimati hipolipemik, a bolesnici sa fibrilacijom atrija antikoagulantne lijekove. ----- Cilj istraživanja je bio ispitati primjerenost medikamentozne terapije u bolesnika koji se liječe od više kroničnih bolesti s posebnim osvrtom na preporuke uzimanja hipolipemika u dijabetičara, u sekundarnoj prevenciji KVB i CVI te anatikoagulantnih lijekova u fibrilaciji atrija. ----- Ispitanici i metode rada. U grupnoj nastavnoj praksi obiteljske medicine koja ima tri liječnika i u skrbi 3000 bolesnika izdvojeni su bolesnici sa dijagnozama šećerne bolesti , CVI-a, IM-a, fibrilacija atrija te bolesnici kojima je ugrađen stent (srčani usadak) i/ili srčana premosnica (baypass). Iz elektronskih zdravstvenih kartona tih bolesnika prikupljeni su podaci o spolu i dobi, dijagnozi osnovne bolesti, odabranim lijekovima koji su neophodni u liječenju te bolesti (statini, beta blokator, antikoagulans), te razlozima zbog kojih taj preporučeni lijek bolesnik ne uzima. Podaci su obrađeni metodama deskriptivne statistike a za testiranje razlika među skupinama bolesnika obzirom na osnovnu bolest i nužnost uzimanja pojedinog lijeka korišten χ2 test. Za statističku analizu podataka korišten je programski paket Microsoft Office Excel. ----- Rezultati. Od ukupno 185 bolesnika njih 103 (55,68%) uzima preporučene lijekove. Usporedbom rezultata uzimanja preporučenih lijekova u skupinama bolesnika sa dijagnozama dijabetesa, fibrilacije atrija, infarkta miokarda, ugradnje srčanog stenta i/ili srčane premosnice te cerebrovaskularnog inzulta utvrđena je statistički značajna razlika među skupinama. U trajnom liječenju 76,47% bolesnika sa dijagnozom CVI, 74% sa dijagnozom IM, 59% sa dijagnozom AF te samo 34% bolesnika sa dijagnozom šećerne bolesti uzimaju propisane preporučene lijekove. ----- Zaključak. Analiza propisivanja lijekova jedan je od bitnih postupaka koji pridonosi primjerenom propisivanju lijekova. Postojanje jasnih, nedvosmislenih smjernica za propisivanje statine u sekundarnoj prevenciji KVB i dijabetesu te antikoagulantnih lijekova u AF omogućava LOM objektivnu prosudbu primjerenosti svoje propisivačke prakse. Rezultati ovakvih istraživanja daju bitan doprinos u oblikovanju sadržaja trajne medicinske izobrazbe u području propisivanja lijekova. |
| Abstract (english) | Cardiovascular diseases (CVDs) are a huge problem for a contemporary man. According to the WHO data, CVDs are the leading cause of mortality both in the contemporary world and in Croatia. Ischemic cardiac disease which leads to myocardial infarction, stent implantation and/or bypass, cerebrovascular insult, and atrial fibrillation have been, among others, caused by risk factors such as dyslipidemia and diabetes. Dyslipidemia leads to atherosclerosis and atherosclerosis is in the background of most CVDs. Type 1 and type 2 diabetes are accompanied by dyslipidemia as a risk factor for complications of diseases. Therefore, the use of hypolipidemic agents is an integral part in treating cardiovascular system diseases caused by atherosclerosis and diabetes.
In 2012, The European Society of Cardiology (ESC) published European Guidelines on Cardiovascular Disease Prevention in clinical practice. It recommends that all the patients after myocardial infarction and cerebrovascular insult should take hypolipidemic agents, while patients with atrial fibrillation should take anticoagulants. ----- The aim of this research was to find out the suitability of medicamentous therapy in patients treated from several chronic diseases with the special reference to the recommendations of taking hypolipidemic agents in diabetics, in secondary prevention of CVDs and CVI and anticoagulants in the atrial fibrillation. ----- Subjects and methods. In the family medicine consisting of three doctors and caring for 3000 patients, patients with diabetes, CVI, IM, atrial fibrillation were singled out, as well as those with stent implantation and/or bypass. Data about their sex and age, diagnosis of their basic illness, chosen medications necessary in the treatment of that disease (statins, beta blockers, anticoagulants) and reasons why this medication was recommended, were taken from e-medical records. Data were processed by descriptive statistic methods. χ2 test was used for testing differences among the groups of patients regarding their basic disease and necessity of taking a certain medication. Microsoft Office Excel was used for the statistical data analysis. ----- Results. Out of 185 patients, 103 (55.68%) take recommended medications. Statistically significant difference among groups was determined by comparing results of taking recommended medications in the groups of patients with diabetes, atrial fibrillation, myocardial infarction, stent implantation and/or bypass and cerebrovascular insults. In the permanent treatment, 76.47% of patients with CVI diagnosis, 74% with IM diagnosis, 59% with AF diagnosis and only 34% with diabetes take recommended medications. ----- Conclusion. The analysis of prescribing medications is one of the important procedures which contributes to the adequate prescribing of medications. The existence of clear, unambiguous guidelines for prescribing statins in the secondary prevention of CVDs and diabetes and anticoagulants in AF enables a GP to make an objective judgement of suitability of his/her prescribing practice. The results of such studies give a significant contribution to permanent medical education in the field of prescribing medications. |
