Türkiye’de geri ödeme önerileri mevcut Avrupa Lipid Kılavuzları’nı kapsıyor mu? İlk akut koroner sendrom ile başvuran hastaların geriye dönük incelenmesi

Do Turkish reimbursement recommendations cover current European Lipid Guidelines? A retrospective analysis of patients presenting with first acute coronary syndrome

Deniz DEMİRCİ, Duygu Ersan DEMİRCİ, Özkan KAYHAN, Murat ESİN, Şakir ARSLAN

Abstract

Objective: This study was a comparison of the statin therapy protocol issued by the European Society of Cardiology (ESC) and the Ministry of Health’s Health Implementation Directive (SUT) in Turkey, performed in order to assess the adequacy of hyperlipidemia treatment indications for primary prevention. Methods: A total of 582 patients with first acute coronary syn- drome were included in the study. Patients with noncritical ste- nosis observed on coronary angiography or a history of ath- erosclerotic disease were excluded. The risk calculation was determined using age, sex, smoking status, presence of dia- betes mellitus, total cholesterol, and lipoprotein levels. Statin treatment indications were evaluated according to the ESC guidelines (2016) and the SUT (2016). Results: Statin treatment was indicated for 96% of diabetic patients, and according to the ESC, it was appropriate for 13.5% of nondiabetic patients, while the SUT recommenda- tion included 13.3% of nondiabetic patients (p190 mg/dL there was greater discrepancy between the SUT and ESC guidelines. According to the SUT, all patients >190 mg/dL are to receive treatment. The ESC had more guidelines than the SUT for cases of LDL- C 60 years of age and those with LDL-C >160 mg/ dL should be reassessed, as they are more limited than those of the ESC. A new treatment algorithm should be defined

Özet

Objective: This study was a comparison of the statin therapy protocol issued by the European Society of Cardiology (ESC) and the Ministry of Health's Health Implementation Directive (SUT) in Turkey, performed in order to assess the adequacy of hyperlipidemia treatment indications for primary prevention.Methods: A total of 582 patients with first acute coronary syndrome were included in the study. Patients with noncritical stenosis observed on coronary angiography or a history of atherosclerotic disease were excluded. The risk calculation was determined using age, sex, smoking status, presence of diabetes mellitus, total cholesterol, and lipoprotein levels. Statin treatment indications were evaluated according to the ESC guidelines (2016) and the SUT (2016).Results: Statin treatment was indicated for 96% of diabetic patients, and according to the ESC, it was appropriate for 13.5% of nondiabetic patients, while the SUT recommendation included 13.3% of nondiabetic patients (p190 mg/dL there was greater discrepancy between the SUT and ESC guidelines. According to the SUT, all patients >190 mg/dL are to receive treatment. The ESC had more guidelines than the SUT for cases of LDLC 60 years of age and those with LDL-C >160 mg/dL should be reassessed, as they are more limited than those of the ESC. A new treatment algorithm should be defined.B irçok çalışma statin tedavisinin kardiyovasküler olayları önlediğini göstermektedir.[1,2] Ancak günümüzde hastalar hala yeterince statin tedavisi alamamaktadır. Bu tedavi ile ilgili bazı sorunlar mevcuttur.[3] Bunlardan biri hastaların önerilen tedavileri yeterince alamamasıdır. Diğeri ise güncel kılavuzların yeterince takip edilmemesi, bu nedenle de gerekli hastaya yeterli dozda statin reçetelenmesinde eksiklik olmasıdır. Çalışmamız önemli bir başka sorunun daha altını çizmektedir ve statin tedavi başlama endikasyonlarının yeterliliğinin incelenmesi gerektiğini vurgulamaktadır. Bu çalışmada Avrupa Kardiyoloji Derneği (ESC) Dislipidemi Kılavuzu'nun statin tedavi endikasyon yeterliliğini ve güncel Sağlık Uygulama Tebliği (SUT) kurallarının ESC lipid kılavuzuna göre kapsamını inceledik.[4,5]