Results of the pilot part of the cardiac drug overdoses hospital registry (storm): focus on drug-induced bradycardia
- Authors: Yakushin S.S.1, Nikulina N.N.1, Filippov E.V.1, Seleznev S.V.1, Lygina E.V.1, Chernysheva M.B.1
-
Affiliations:
- Ryazan State Medical University
- Issue: Vol 28, No 2 (2020)
- Pages: 153-163
- Section: Original study
- URL: https://journals.rcsi.science/pavlovj/article/view/34904
- DOI: https://doi.org/10.23888/PAVLOVJ2020282153-163
- ID: 34904
Cite item
Abstract
Aim. Analysis of the relevance of drug-induced bradycardia (DIB) as a medical and social problem, its main regularities and determination of the need for further study of this issue.
Materials and Methods. The register study was performed on 01 Jan 2017-30 Jun 2018 (18 months) at the clinical base of the Ryazan Regional Clinical Cardiology Dispensary. Inclusion criteria were: 1) bradycardia/bradyarrhythmia syndrome with intake of at least one drug with a bradycardic effect (BCE), 2) signing Informed consent to the processing of personal and clinical data. No additional interventions were performed in the diagnosis or treatment of patients within the registry.
Results. During 18 months, 191 patients (age 77.0 [69.0;82.0] years, 26.7% of men) were hospitalized with a verified diagnosis of DIB, which accounted for 52.6% of all cases of hospitalization for drug overdose. During the analyzed period, there was an increase in both the total number of drug overdoses (1.7 times, p<0.001) and overdoses of drugs with BCE (1.8 times, p<0.001). Main clinical manifestations of DIB: reduced heart rate (<50 beats/min – 80.0%, <40 beats/min – 51.1%), sinoatrial (30.4%) and atrioventricular blocks (1st degree – 8.2%, 2nd degree – 10.4%, 3rd degree – 14.1%), syncope (32.6%) and cardiac pauses >3 s (7.4%). Almost all (94.8%) the patients were hospitalized by ambulance, 40.7% – to the intensive care unit; 17.8% required pacemaker implantation; hospital mortality was 5.2%. More than half (54.5%) of hospitalized patients took ≥2 drugs with BCE, 15.7% – ≥3 and 3.14% – ≥4 (both in monotherapy and as a part of a combination): beta-blockers – 68.4%, antiarrhythmic preparations – 38.9%, digoxin – 25.8%, non-dihydropyridine calcium antagonists – 10.5%, I1-imidazoline receptor agonist – 9.5%, and other drugs with BCE – 7.4%. To analyze the cause of DIB, we used clinical data of 135 patients (age 77.0 [69.0;82.0] years, 20.7% of men), who could indicate the exact dose of a taken drug with BCE. Among them, the absolute exceedance of the recommended dose of drugs with BCE was found in 14.1% of cases, while in 85.9% of cases summation/potentiation effect of several drugs with ВСЕ was observed, with intake of each in a therapeutic dose.
Conclusion. The study confirmed high medical and social significance of the problem of DIB, which requires attention of practitioners, pharmacologists and clinical pharmacologists, health care providers, and also continuation of its study.
Full Text
##article.viewOnOriginalSite##About the authors
Sergey S. Yakushin
Ryazan State Medical University
Email: maria-kiryukhina@mail.ru
ORCID iD: 0000-0002-1394-3791
SPIN-code: 7726-7198
ResearcherId: A-9290-2017
MD, PhD, Professor, Head of the Department of Hospital Therapy with a Medical and Social Expertise Course
Natal`ya N. Nikulina
Ryazan State Medical University
Email: maria-kiryukhina@mail.ru
ORCID iD: 0000-0001-8593-3173
SPIN-code: 9486-1801
ResearcherId: A-8594-2017
MD, PhD, Associate Professor, Professor of the Department of Hospital Therapy with a Medical and Social Expertise Course
Russian Federation, RyazanEvgenii V. Filippov
Ryazan State Medical University
Email: maria-kiryukhina@mail.ru
ORCID iD: 0000-0002-7688-7176
SPIN-code: 2809-2781
ResearcherId: O-1490-2016
MD, PhD, Associate Professor, Head of the Department of Outpatient Therapy and Preventive Medicine
Russian Federation, RyazanSergey V. Seleznev
Ryazan State Medical University
Email: maria-kiryukhina@mail.ru
ORCID iD: 0000-0002-4069-8082
SPIN-code: 4532-5622
ResearcherId: C-8725-2017
MD, PhD, Associate Professor of the Department of Hospital Therapy with a Medical and Social Expertise Course
Russian Federation, RyazanElena V. Lygina
Ryazan State Medical University
Email: maria-kiryukhina@mail.ru
ORCID iD: 0000-0001-6746-6743
SPIN-code: 9655-8070
ResearcherId: T-2974-2017
MD, PhD, Associate Professor of the Department of Hospital Therapy with a Medical and Social Expertise Course
Russian Federation, RyazanMariya B. Chernysheva
Ryazan State Medical University
Author for correspondence.
Email: maria-kiryukhina@mail.ru
ORCID iD: 0000-0002-5460-5027
Сlinical Resident of the Department of Hospital Therapy with a Medical and Social Expertise Course
Russian Federation, RyazanReferences
- Naghavi M, Wang H, Lozano R, et al. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385:117-71. doi: 10.1016/S0140-6736(14)61682-2
- Demograficheskiy ezhegodnik Rossii. 2015: statisticheskiy sbornik. Moscow: Rosstat; 2015. (In Russ).
- Townsend N, Wilson L, Bhatnagar P, et al. Cardiovascular disease in Europe: epidemiological update 2016. European Heart Journal. 2016;37(42):3232-45. doi:101093/eurheartj/ehw334
- Cardiovascular prevention 2017. National Guidelines. Russian Journal of Cardiology. 2018;(6):7-122. (In Russ). doi: 10.15829/1560-4071-2018-6-7-122
- Filippov EV, Vorobyev AN, Dobrynina NV, et al. Adverse cardiovascular outcomes and their relationship with risk factors according to the prospective study MERIDIAN-RO. Russian Journal of Cardiology. 2019;24(6):42-8. (In Russ). doi: 10.15829/1560-4071-2019-6-42-48
- Balanova YuA, Shalnova SA, Imaeva AE, et al. Prevalence, Awareness, Treatment and Control of Hypertension in Russian Federation (Data of Observational ESSE-RF-2 Study). Rational Pharmacotherapy in Cardiology. 2019;15(4):450-66. (In Russ). doi: 10.20996/1819-6446-2019-15-4-450-466
- Filippov EV, Zaikina EV, Nikulina NN. Is existence of clinically significant anxiety and depression a new risk factor for chronic non-infectious diseases? Nauka Molodykh (Eruditio Juvenium). 2019;7(1): 28-37. (In Russ). doi: 10.23888/HMJ20197128-37
- Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018;39: 3021-104. doi: 10.1093/eurheartj/ehy339
- Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37:2893-962. doi:10.1093/ eurheartj/ehw210
- Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2016;37:2129-200. doi: 10.1093/eurheartj/ehw128
- Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal. 2019;00:1-71. doi: 10.1093/eurheartj/ehz425
- Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. European Heart Journal. 2015;36:2793-867. doi: 10.1093/eurheartj/ehv316
- Loukianov MM, Boytsov SA, Yakushin SS, et al. Concomitant cardiovascular diseases and antihypertensive treatment in outpatient practice (by the RECVASA registry data). Rational Pharmacothe-rapy in Cardiology. 2016;12(1):4-15. (In Russ).
- Oganov RG, Simanenkov VI, Bakulin IG, et al. Comorbidities in clinical practice. Algorithms for diagnostics and treatment. Cardiovascular Therapy and Prevention. 2019;18(1):5-66. (In Russ). doi:10. 15829/1728-8800-2019-1-5-66
- Kukes VG, Sychev DA. Klinicheskaja farmakologija. 5th ed. Moscow: GJeOTAR-Media; 2017. (In Russ).
- Nikulina NN. The role of pathoanatomical departments in improving medical education (literature review). I.P. Pavlov Russian Medical Biological Herald. 2016;(1):142-8. (In Russ).
- Barbarash OL, Bojcov SA, Vajsman DSh, et al. Position Statement on Challenges in Assessing Cause-Specific Mortality. Complex Issues of Cardiovascular Diseases. 2018;7(2):6-9. (In Russ). doi:10. 17802/2306-1278-2018-7-2-6-9
- Boitsov SА, Yakushin SS, Liferov RA, et al. In-depth analysis of the spread of acute forms of coronary heart disease and their mortality in the town of Ryazan (within the framework of the RESONANCE multicenter study). Kardiologicheskij Vestnik. 2008; 3(2):31-8. (In Russ).
- Sychev DA, Bordovsky SP, Danilina KS, et al. Inappropriate prescribing in older people: STOPP/START criteria. Clinical Pharmacology and Theraphy. 2016;25(2):76-81. (In Russ).