Patient with stable ischemic heart disease in Ukraine and Europe: The CLARIFY registry 5-year results

Abstract

CLARIFY (The prospeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) is a large multicenter project in the patients with a stable coronary artery disease (CAD). Within 5 years (2009–2014) 32,703 patients with confirmed diagnosis of CAD from 45 countries worldwide took part in the registry. Study results have demonstrated the significant differences between the current international standards of management and real-life clinical practice. Despite the fact that Ukrainian doctors actively used the complete list of the medicinal products recommended in the stable CAD (ASA, statins, BBs, ivabradine, ACE inhibitors), the control of therapy efficacy was very low and not only relative to the symptoms (after 5-year follow-up, angina attacks were persistent in 74 % of patients versus 16.9 % of the European patients). It should be noted that the clinical status of patients enrolled in Ukraine was more severe compared with the general group: 24.1 % of patients with the severe angina (ІІІ FC), in Europe – 2.2 %, in the world population – 1.6 %. Rate of the myocardial revascularization (surgical, endovascular) was very low in Ukraine as for 5-year study – only 5.9 %. As a result, our patients had 2-fold need in the hospitalization, 2-fold rate of fatal MI and acute cerebrovascular accidents (stroke + TIA) and 3-fold rate of the unstable angina. Control of such main risk factors of CAD, as BP levels < 140/90 mm Hg, LDL cholesterol levels < 1.8 mmol/L, HR < 70 beats per minute was insufficient both in the Ukrainian and global populations. During the study both Ukrainian and European patients have not demonstrated the dynamics in life style modification (majority of subjects continued sedentary lifestyle, were overweight, had signs of the abdominal obesity and smoked). Taking into consideration the results of the CLARIFY study, significant optimization of management of patients with stable CAD is still necessary.