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Srpski arhiv za celokupno lekarstvo 2016 Volume 144, Issue 11-12, Pages: 590-596
https://doi.org/10.2298/SARH1612590I
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The effects of implementation of guideline-directed medical therapy on relief of angina in patients with stable coronary artery disease in Serbia

Ilić Ivan (School of Medicine, Belgrade + Clinical Hospital Center Zemun, Department of Cardiology, Belgrade)
Stanković Ivan ORCID iD icon (School of Medicine, Belgrade + Clinical Hospital Center Zemun, Department of Cardiology, Belgrade)
Janićijević Aleksandra (School of Medicine, Belgrade + Clinical Hospital Center Zemun, Department of Cardiology, Belgrade)
Kušić Jovana (School of Medicine, Belgrade + Clinical Hospital Center Zemun, Department of Nephrology, Belgrade)
Vidaković Radosav (School of Medicine, Belgrade + Clinical Hospital Center Zemun, Department of Cardiology, Belgrade)
Otašević Petar (School of Medicine, Belgrade + Dedinje Cardiovascular Institute, Department of Cardiology, Belgrade)
Andrić Vesna (Institute for Health Care of Railway Workers, Department of Internal Medicine, Belgrade)
Poznanović Snežana (Public Health Center, Veliko Gradište)
Petrović Ivana (School of Medicine, Belgrade + Public Health Center Vračar, Belgrade)
Burazor Ivana (School of Medicine, Belgrade + Rehabilitation Clinic “Dr Miroslav Zotović”, Belgrade)
Ristić Arsen ORCID iD icon (School of Medicine, Belgrade + Clinical Center of Serbia, Cardiology Clinic, Belgrade)
Ilić Stevan (Faculty of Medicine, Niš + Niška Banja Institute, Niška Banja)
Benc Dragan (Faculty of Medicine, Novi Sad + Institute for Cardiovascular Diseases, Clinic of Cardiology, Sremska Kamenica)
Davidović Goran ORCID iD icon (Faculty of Medical Sciences, Kragujevac + Clinical Center of Kragujevac, Kragujevac)
Stojković Gabrijela (General Hospital, Leskovac)
Putniković Biljana (School of Medicine, Belgrade + Clinical Hospital Center Zemun, Department of Cardiology, Belgrade)
Nešković Aleksandar N. ORCID iD icon (School of Medicine, Belgrade + Clinical Hospital Center Zemun, Department of Cardiology, Belgrade)

Introduction. Adherence to proposed lifestyle changes and prescribed medication in patients with stable coronary artery disease (SCAD) is poor. Objective. We sought to investigate the influence of adjusting guideline proposed medications on relief of angina in a large group of patients with SCAD in Serbia. Methods. The study included a total of 3,490 patients from 15 cardiology clinics with symptoms of stable angina and at least one of the following criteria: abnormal electrocardiogram (ECG), history of myocardial infarction (MI), positive stress test, significant coronary artery disease on coronary angiogram or previous revascularization. All the patients underwent comprehensive evaluation at initial visit and after two months. The relief of angina was study end-point defined as any reduction in Canadian Cardiology Society (CCS) class, number of angina attacks per week and/or number of tablets of short-acting nitrates per week. Results. Most patients were included based on abnormal ECG (48.4%). At Visit 1, the average number of prescribed classes of medications to a single patient increased from 4.16 ± 1.29 to 4.63 ± 1.57 (p < 0.001). At the follow-up, the patients had significantly lower blood pressure (141 ± 19 / 85 ± 11 vs. 130 ± 12 / 80 ± 8 mmHg; p < 0.001) and most of them reported CCS class I (63.3%). The average weekly number of angina attacks was reduced from 2.82 ± 2.50 at Visit 1 to 1.72 0 ± 1.66 at Visit 2, as well as average weekly use of short-acting nitrates to treat these attacks (2.69 ± 2.53 to 1.74 ± 1.47 tablets; p < 0.001 for all). Conclusion. Adjustment of prescribed medications to guideline recommendations in a large Serbian patient population with prevalent risk factors led to significant relief of angina.

Keywords: stable coronary artery disease, guidelines, medical therapy, trimetazidine