WHAT DO PATIENTS WITH ATRIAL FIBRILLATION KNOW ABOUT STROKE AND SYSTEMIC EMBOLISM PREVENTION? DATA OF THE PRIMA-TERRA REGISTRY

Aim. To study the awareness and opinion of patients with atrial fibrillation (AF) about the stroke prevention.Material and methods. This study based on the questionnaire survey of 544 patients from three regions of Russia is the third part of the PRIMA-TERRA register. The survey was carried out in the period from 01.12.2012 to 01.07.2013 by independent employees on a special questionnaire of 9 questions. The ratio of men and women was 42% vs 58%, respectively, the average age was 65.6Ѓ}8.2 years. The AF duration was 7.6Ѓ}2.0 years. The average score of CHA2DS2-VASc was 3.4Ѓ}1.4.Results. Less than 70% of patients were informed of possible AF complications, of which less than a third – about the risk of stroke. Only 62% of patients believed that they take drugs for the stroke prevention, of which only 31% took warfarin, 15% new oral anticoagulants (NOAC). The majority of patients received antiplatelet agents and their combinations – medications not recommended for this purpose by modern National and European cardiology guidelines. Less than 60% of the respondents were informed about the NOACs, while clinically significant information about the benefits of this group of drugs was provided by doctors only to 18% of patients. The main reason limiting the widespread use of NOACs is the high cost of these drugs.Conclusion. Awareness of patients about AF thromboembolic complications is extremely inadequate. For the prevention of stroke, most patients take antiplatelet agents and their combinations, less than a half – anticoagulants. The main reason for refusing to receive the NOACs is the high cost of this group of drugs

Incidence and structure of sudden cardiac death among working population of the Bryansk region. GERMINA register data

Aim. To study the incidence and structure of sudden cardiac death (SCD) among the working population of the Bryansk region, as well as to determine its share in the structure of total and cardiovascular mortality in this age group.Material and methods. We analyzed the structure and incidence of SCD in 417740 people of working age (25-64 years) in five major areas of the Bryansk region and the city of Bryansk in 2012. Medical records (outpatient card, patient’s chart, autopsy protocol, a medical certificate of death) of 1447 people of working age who died from diseases of the circulatory system were analyzed.Results. 106 cases corresponded to the criteria for SCD, which determined the frequency of SCD 25.4 per 100000 working-age population. The predominance of men over women (85% vs 15%) was marked. Only 24% of cases of SCD occurred in hospitals, while 76% - in outpatient settings. A strong association between SCD and age was noted. Chronic (43%) and acute (37%) forms of ischemic heart disease turned out to be the main clinical entities that caused SCD.Conclusion. The share of SCD in total and cardiovascular mortality was 2.9% and 7.3% respectively. Strong correlation between SCD rate and age was found. Chronic and acute forms of ischemic heart disease turned out to be the main clinical entities that caused SCD

IMPACT OF ALCOHOL CONSUMPTION ON SUDDEN CARDIAC DEATH OCCURENCE BY THE REGISTRY GERMINA (REGISTRY OF SUDDEN CARDIAC DEATH OF ECONOMICALLY ACTIVE INHABITANTS IN BRYANSK REGION)

Aim. To investigate on the role of alcohol in sudden cardiac death onset (SCD) in economically active inhabitants.Material and methods. Totally, medical documentation was analyzed, of 1447 economically active inhabitants of Bryansk region in 2012, died due to circulatory causes: the outpatient chart, the inpatient chart, medical death certificate, forensic autopsy, common autopsy. The SCD criteria fulfilled 106 cases. With a unified questionnaire, 26 relatives were surveyed, and medical staff, of those who agreed to respond. In section of 61 corpse, alcohol concentration was measured, with the level of intoxication defined.Results. By the data from official documents, the part of alcohol cardiomyopathy (ICD I42.6) was 7% from all death cases of suddenly died economically active inhabitants. Outpatient charts and case histories documented the fact of alcohol abuse in 36% of those who requested medical help while alive. Relatives or medical staff, contacted with the died just before the death, confirmed alcohol overconsumption in 42%. Corpse blood investigation revealed 27% specimens with alcohol, and about a half of cases the concentration was at more than moderate intoxication.Conclusion. Alcohol plays significant role in SCD development in economically active inhabitants. Abuse with the alcohol beverages leads to development and progression of structural and functonal changes in the heart — the substrate for life-threatening ventricular arrhythmias. Also, in many cases alcohol might be the trigger for fatal rhythm disorders

Arterial hypertension epidemiology in Bryansk Region: prevalence, awareness, treatment, and control

Aim. To study the dynamics of arterial hypertension (AH) epidemiology in urban and rural population of Bryansk Region, aged 19-64 years. To evaluate AH awareness, treatment, and control in the local healthcare settings. Material and methods. Random representative samples of the urban and rural Bryansk Region population - men and women aged 19-64 years - were selected. The study sample was constructed in three stages: selection of policlinics and central regional hospitals; selection of healthcare catchment areas; and selection of households (flats). At the first stage, a random urban and rural sample of 2345 people (response rate 78%) was examined; at the third stage, a sample of 1909 individuals (response rate >70%) was examined. The data were collected using a unified registration form (140-1/u). The study was performed as a part of the Target Federal Program, Ministry of Health. Results. In rural men and women, AH prevalence was 25,9% and 35,4%, while in their urban peers, it was 30% and 38,6%, respectively. The respective levels of AH awareness in urban and rural participants varied from 87,5% to 90,4%, and from 86,6% to 94,6%. In rural and urban samples, AH treatment percentages were 60,3%-76,8% and 77,5%-82,9%, respectively. Effective blood pressure control was achieved in 14,3%-13,8% and 10,1%-29,8% of rural and urban AH patients, respectively. The most popular antihypertensive medications were ACE inhibitors (59,0%–64,1%), diuretics (34,8%–37,0%), beta-adrenoblockers (12,8%–31,6%), and calcium antagonists (10,5%–12,4%). Conclusion. The urban population of Bryansk Region demonstrated higher levels of AH prevalence, awareness, treatment, and especially control throughout the four-year follow-up period

Cohort profile. the ESC-EORP chronic ischemic cardiovascular disease long-term (CICD LT) registry

The European Society of cardiology (ESC) EURObservational Research Programme (EORP) Chronic Ischemic Cardiovascular Disease registry Long Term (CICD) aims to study the clinical profile, treatment modalities and outcomes of patients diagnosed with CICD in a contemporary environment in order to assess whether these patients at high cardiovascular risk are treated according to ESC guidelines on prevention or on stable coronary disease and to determine mid and long term outcomes and their determinants in this population

Physicians' guideline adherence is associated with long-term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry

Background: Physicians' adherence to guideline-recommended therapy is associated with short-term clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). However, its impact on longer-term outcomes is poorly documented. Here, we present results from the 18-month follow-up of the QUALIFY registry. Methods and results: Data at 18 months were available for 6118 ambulatory HFrEF patients from this international prospective observational survey. Adherence was measured as a continuous variable, ranging from 0 to 1, and was assessed for five classes of recommended HF medications and dosages. Most deaths were cardiovascular (CV) (228/394) and HF-related (191/394) and the same was true for unplanned hospitalizations (1175 CV and 861 HF-related hospitalizations, out of a total of 1541). According to univariable analysis, CV and HF deaths were significantly associated with physician adherence to guidelines. In multivariable analysis, HF death was associated with adherence level [subdistribution hazard ratio (SHR) 0.93, 95% confidence interval (CI) 0.87–0.99 per 0.1 unit adherence level increase; P = 0.034] as was composite of HF hospitalization or CV death (SHR 0.97, 95% CI 0.94–0.99 per 0.1 unit adherence level increase; P = 0.043), whereas unplanned all-cause, CV or HF hospitalizations were not (all-cause: SHR 0.99, 95% CI 0.9–1.02; CV: SHR 0.98, 95% CI 0.96–1.01; and HF: SHR 0.99, 95% CI 0.96–1.02 per 0.1 unit change in adherence score; P = 0.52, P = 0.2, and P = 0.4, respectively). Conclusion: These results suggest that physicians' adherence to guideline-recommended HF therapies is associated with improved outcomes in HFrEF. Practical strategies should be established to improve physicians' adherence to guidelines. © 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiolog