Vol 15, No 3 (2024)

BACKGROUND: The opinion of doctors regarding the current issue of low patient adherence to modern medicine will help identify weaknesses in the system and methods to improve them.

AIM: To assess the doctors’ opinion regarding the problem of adherence to outpatient treatments.

MATERIALS AND METHODS: Using an online survey form (nine questions regarding adherence to outpatient treatments), 105 doctors were surveyed, including general practitioners (GPs; 51%), therapists (27%), cardiologists (21%), and other specialties (1%). The survey results were processed using hierarchical cluster analysis.

RESULTS: The following clusters were identified: cluster 1 (K1), which included 62 respondents (GPs, 63% and therapists, 32%); and cluster 2 (K2), which included 43 respondents (cardiologists, 47%; and GPs, 35%). Doctors in both the clusters correctly determined the adherence to treatment (K1=77%, K2=88%; p=0.531), followed clinical practice guidelines when diagnosing a patient with cardiovascular disease (K1=66%, K2=88%; p=0.020), believed that the doctor’s behavior influences the patient’s adherence (K1=86%, K2=98%; p=0.045), and believed that patients should be educated regarding their disease (K1=84%, K2=100%, p=0.005). They believed that the most significant topics to be taught were arterial hypertension, heart failure (HF), coronary artery disease, arrhythmia, and chronic kidney disease (K1=81%, K2=86%; p=0.876). Furthermore, they agreed that the use of technology and mobile apps (K1=61%, K2=70%, p=0.371) could increase patient adherence to treatment. Twenty doctors correctly identified the medications indicated for HF with reduced ejection fraction to improve patient prognosis (K1=2, K2=18; p <0.001). The remaining respondents answered partially correctly (K1=97%, K2=58%; p <0.001). The respondents identified that the lack of time at appointments to explain and improve the patient’s motivation for treatment (K1=47%, K2=47%, p=0.226) and the patient’s low health literacy (K1=26%, K2=35%; p=0.226) were the most significant reasons for low adherence.

CONCLUSION: Most physicians providing outpatient services are aware of the concept of medication adherence and following clinical practice guidelines when managing patients with cardiovascular pathology. The lack of sufficient time for outpatient appointments and the patient’s low health literacy are the leading factors of low adherence to treatment. Thus, the doctors unanimously believe that educating patients regarding their disease will increase adherence to treatment.

Currently, there is an active search for new biomarkers and therapeutic targets to develop effective approaches to risk stratification and secondary prevention of cardiovascular diseases (CVD). Microribonucleic acids (miRNAs) are of particular interest to investigators. MiRNAs are endogenous small noncoding RNAs that regulate the transcription of factors that play a role in the proliferation, differentiation, cell growth, and tissue remodeling processes in CVD. MiRNA-378 is currently being analyzed as a biomarker for CVD. Thus, in this review, we aimed to describe the regulatory role of miRNA-378 and provide strong evidence for its feasibility as a biomarker. Further preclinical and clinical studies are required to identify the potential benefits of miRNA-378 as a biomarker in CVD.

BACKGROUND: Modern data have expanded our understanding of the pathogenetic mechanisms and clinical and laboratory findings in a patient with Takotsubo syndrome (TS). Nonetheless, its timely diagnosis and treatment remain challenging. All patients are initially treated according to the acute coronary syndrome protocol, with a "working" diagnosis of myocardial infarction without an obstructive lesion in the coronary arteries. However, the treatment of in-hospital complications of TS has its limitations and specific features.

CLINICAL CASE DESCRIPTION: Herein, we have reported a case of TS that presented with the classic apical ballooning of the left ventricular apex, which had developed without an obvious stress factor, which is quite rare. The disease was complicated by the development of cardiogenic shock (CGS) and transient obstruction of the left ventricular outflow tract (LVOTO), which reportedly occurs in about 25% of the patients. CGS in patients with TS is a life-threatening complication and a challenging therapeutic problem, especially when it is also associated with a dynamic LVOTO. In such conditions, the only therapeutic option is mechanical circulatory support. However, in our patient, low doses of dobutamine were used to stabilize the patient’s hemodynamics. This treated produced a good therapeutic effect.

CONCLUSION: Our case report findings emphasize the need for further research into the mechanisms of LVOTO development in TS, as well as the development of standardized approaches for the treatment of such patients in the acute phase of the disease.