| Abstract | CILJ ISTRAŽIVANJA
Cilj ovog preglednog rada je prikazati patofiziološku pozadinu fibrilacije atrija, naglasiti opasnosti
neodgovarajućeg liječenja te prikazati farmakološke mogućnosti liječenja, vodeći se aktualnim
smjernicama. Ovaj rad prikazat će aktualne smjernice farmakološkog liječenja fibrilacije atrija i
pridružene zdravstvene rizike takvog liječenja.
Osim toga, cilj ovog rada jest prikazati i rezultate istraživanja u kojem je mjerena adherencija na
propisanu farmakoterapiju za liječenje FA na određenom uzorku ispitanika. Ovako bi se mogao
pronaći potencijalni problem u čije bi se rješavanje mogli uključiti ljekarnici te na taj način
potencijalno doprinjeti kvaliteti zdravstvene skrbi.
MATERIJAL
U svrhu prikaza optimalnih farmakoterapijskih modaliteta pretražena je literatura u bibliografskim
bazama prema temi istraživanja, predmetu istraživanja, autorima i časopisu. Pregledane su i
proučene na analitički i kritički način kliničke smjernice, pregledni članci, meta-analize, originalni
znanstveni radovi, stručni radovi relevantni za problematiku ovoga specijalističkog rada. Pritom su
izdvojeni i u radu sažeto prikazani najvažniji rezultati, rasprave i zaključci. Na temelju proučavanih
članaka izvedena su vlastita razmatranja proučavane problematike.
U svrhu prikupljanja podataka za ispitivanje adherencije na propisanu farmakoterapiju FA korišten je
upitnik s Morisky ljestvicom od 8 pitanja (MMAS-8). Upitnik su popunjavali ispitanici prilikom dolaska
u ljekarničku jedinicu I, ZU Ljekarne Perković.
U ispitivanje nisu uključeni bolesnici kojima je dijagnosticirana fibrilacija atrija unutar zadnjih 6
mjeseci, bolesnici kod kojih je došlo do ozbiljne promjene zdravstvenog stanja, trenutno
hospitalizirani bolesnici, maloljetne osobe, bolesnici s demencijom u anamnezi i oni koji nisu
sposobni za samostalno odlučivanje i/ili život.
U istrživanju je sudjelovalo 39 ispitanika.
REZULTATI
Pregled predmetne literature navodi tri glavna cilja terapije FA koja su u radu detaljno raspravljena:
kontrolu simptoma FA, smanjenje rizika od tromboembolijskih događaja (prvenstveno moždanog
udara) i prevenciju kardiomiopatije izazvane aritmijom.
U farmakoterapiji FA se izrazito često koriste lijekovi s uskom terapijskom širinom poput oralnih
antikoagulansa i digoksina radi čega je optimizacija farmakoterpije u ovih bolesnika naročito
izazovna.
Od 39 ispitanika, visoku adherenciju (8 bodova) je po MMAS-8 ljestvici imalo 19 ispitanika (48.7%).
Djelomična adherencija (6 do <8 bodova) se pokazala kod 12 isptanika (30.8 %) dok se niska
adherencija (0 do <6 bodova) pokazala kod 8 ispitanika (20.5 %).
ZAKLJUČAK
U ovom radu prikazan je određeni broj terapisjkih modaliteta kao i problematika koja prati
suvremenu farmakotarpiju FA što može biti od velike koristi za zdravstvene djelatnike (poput
ljekarnka) koji sudjeluju u provođenju adekvatne farmakoterpije FA. Osim toga zabilježen je i veliki
stupanj neadherencije u ispitanika s FA što predstavlja potencijalno mjesto djelovanja ljekarnika u
svrhu unapređenja ljekarničke skrbi kao i kvalitete zdravstvenog sustava. |
| Abstract (english) | OBJECTIVES
The objective of this review is to show the pathophysiological background of atrial fibrillation, to
highlight the hazards of inadequate treatment and to show the pharmacological possibilities of
treatment, according to current guidelines. This review will show current guidelines for
pharmacological treatment of atrial fibrillation and associated health risks of such therapy.
In addition, the objective of this paper is to present the results of the study in which the adherence
to the prescribed pharmacotherapy for the treatment of AF was measured on a given sample of
subjects. This way, a potential problem could be found in which pharmacists could be involved, thus
potentially contributing to the quality of health care.
MATERIAL
For the purpose of presenting optimal pharmacotherapeutic modalities, literature was searched in
bibliographic databases according to the research topic, research subject, authors and journal. An
analytical and critical review of clinical guidelines, review articles, meta-analysis, original scientific
papers, and expert papers relevant to the issue of this review have been reviewed and analyzed. In
addition, the most important results, discussions and conclusions are summarized in this review.
Based on the studied articles, discussions of the studied problems were presented.
For the purpose of collecting data for adherence study of prescribed AF pharmacotherapy, a
questionnaire with a Morisky 8 question scale (MMAS-8) was used. The questionnaire was filled by
the subjects when they came to the pharmacy unit I of ZU Ljekarne Perković.
The study did not include patients diagnosed with atrial fibrillation within the last 6 months, patients
with serious health status changes, currently hospitalized patients, underage patients, patients with
history of dementia and those who are incapable of independent decision-making and/or living.
39 subjects participated in the study.
RESULTS
The review of the subject literature cites three main goals of AF therapy, which are discussed in
detail: control of AF symptoms, reduction of thromboembolic events (primarily ischemic stroke) and
prevention od arrhythmia-induced cardiomyopathy.
AF pharmacotherapy very often requires administration of medicies with narrow therapeutic index
such as oral anticoagulants and digoxin for which pharmacotherapeutical optimization in these
patients can be particularly challenging.
Out of 39 subjects, high adherence (8 points) was found 19 in subjects (48.7%) by the MMAS-8 scale.
Medium adherence (6 to <8 points) was found in 12 subjects (30.8%) while low adherence (0 to <6
points) was found in 8 subjects (20.5%).
CONCLUSION
This review presents a number of therapeutic modalities as well as issues that accompany the
current AF pharmacotherapy which can be of great benefit to healthcare professionals (such as
pharmacists) involved in AF pharmacotherapy optimisation. In addition, there was a high degree of
nonadherence in the subjects with AF, which represents a potential target for the pharmacists to
improve pharmaceutical care as well as the quality of the health system. |
