Приверженность медикаментозной терапии у пациентов после острого инфаркта миокарда: систематический обзор литературы
Аннотация
Цель. Систематический анализ современных подходов к оценке и улучшению приверженности медикаментозной терапии у пациентов после острого инфаркта миокарда на амбулаторно-поликлиническом этапе наблюдения, с особым акцентом на факторы, влияющие на соблюдение режима лечения, и роль многодисциплинарного подхода;
Материалы и методы. Проведен систематический обзор литературы, посвященной проблемам приверженности медикаментозной терапии после острого инфаркта миокарда. Анализированы данные крупных международных исследований, включая метаанализ 10 исследований с участием 106 002 пациентов, научное заявление Американской ассоциации сердца 2023 года, рекомендации ESC 2023 и ACC/AHA 2025 года, а также современные программы кардиологической реабилитации.
Результаты. Метаанализ показал, что хорошая приверженность медикаментозной терапии ассоциируется со снижением общей смертности (отношение рисков 0,56; 95% ДИ: 0,45-0,69), сердечно-сосудистой смертности (ОР 0,66; 95% ДИ: 0,51-0,87) и частоты госпитализаций (ОР 0,61; 95% ДИ: 0,45-0,82). Неприверженность терапии наблюдается у 30% пациентов после инфаркта миокарда. Совместное принятие решений, структурированные программы кардиологической реабилитации и вовлечение многодисциплинарных команд значительно улучшают долгосрочную приверженность лечению.
Заключение. Приверженность медикаментозной терапии является ключевым фактором улучшения прогноза у пациентов после острого инфаркта миокарда. Мультидисциплинарный подход, включающий совместное принятие решений, обучение пациентов, фармацевтическое консультирование и использование цифровых технологий, демонстрирует наибольшую эффективность в повышении приверженности терапии.
Об авторах
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Copyright (c) 2025 Д.Д. Сохибов , Р.Х. Тригулова , Н.С. Мирахмедова (Автор)
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