Reducing geographic inequalities in access times for acute treatment of myocardial infarction in a large country: the example of Russia.

Background: Russia has the largest area of any country in the world and has one of the highest cardiovascular mortality rates. Over the past decade, the number of facilities able to perform percutaneous coronary interventions (PCIs) has increased substantially. We quantify the extent to which the constraints of geography make equitable access to this effective technology difficult to achieve. Methods: Hospitals performing PCIs in 2010 and 2015 were identified and combined with data on the population of districts throughout the country. A network analysis tool was used to calculate road-travel times to the nearest PCI facility for those aged 40+ years. Results: The number of PCI facilities increased from 144 to 260 between 2010 and 2015. Overall, the median travel time to the closest PCI facility was 48 minutes in 2015, down from 73 minutes in 2010. Two-thirds of the urban population were within 60 minutes' travel time to a PCI facility in 2015, but only one-fifth of the rural population. Creating 67 new PCI facilities in currently underserved urban districts would increase the population share within 60 minutes' travel to 62% of the population, benefiting an additional 5.7 million people currently lacking adequate access. Conclusions: There have been considerable but uneven improvements in timely access to PCI facilities in Russia between 2010 and 2015. Russia has not achieved the level of access seen in other large countries with dispersed populations, such as Australian and Canada. However, creating a relatively small number of further PCI facilities could improve access substantially, thereby reducing inequality

How has the management of acute coronary syndrome changed in the Russian Federation during the last 10 years?

METHODS: We report trends and patterns of percutaneous cardiovascular interventions (PCI) by region for 2005-2009, with more detailed data on management of myocardial infarctions in 2009-2103, relating them to regional economic development and changes in mortality from myocardial infarction. RESULTS: PCIs per 100,000 population increased from 8.7 in 2005-71.3 in 2013, with considerable regional variation. In 2013 the highest rates were in the wealthiest regions, although not in some remote regions dependent on oil and mineral extraction. Between 2009 and 2013 rates of thrombolysis in those with acute myocardial infarctions potentially eligible for treatment remained broadly similar at about 28% but rates of primary revascularisation with stenting rose rapidly, from 6.5% to 23.7%. In-hospital mortality from myocardial infarction since 2009 has declined most in regions achieving highest rates of primary revascularisation. CONCLUSIONS: The sustained investment in advanced cardiovascular technology has been associated with substantial increases in revascularisation in some but not all regions. However, rates overall remain far behind those in Western Europe. Further research is in progress to understand the reasons for these variations and the barriers to further expansion of services

Management of patients with acute ST-segment elevation myocardial infarction in Russian hospitals adheres to international guidelines

Objective - Russia has one of the highest cardiovascular mortality rates. Modernisation of the Russian health system has been accompanied by a substantial increase in uptake of percutaneous coronary intervention (PCI), which substantially reduces the risk of mortality in patients with acute ST-elevation myocardial infarction (STEMI). This paper aims to describe contemporary Hospital treatment of acute STEMI among patients in a range of hospitals in the Russian Federation. Methods - This study used data from a prospective observational cohort of 1128 suspected patients with myocardial infarction recruited in both PCI and non-PCI hospitals across 13 regions and multiple levels of the health system in Russia. The primary objective was to examine the use of reperfusion strategies in patients with STEMI. Results - Among patients reaching PCI centres within 12 hours of symptom onset, the vast majority received angiography and PCI, regardless of age, sex and comorbidity, in line with current European Society of Cardiology guidelines. Conclusion- Patients reaching Russian hospitals are very likely to receive appropriate treatment, although performance varies. The best hospitals can serve as beacons of good practice as PCI facilities continue to expand across Russia where geography allows

COVID-19: seroprevalence and adherence to preventive measures in Arkhangelsk, Northwest Russia

Background - The published estimates of SARS-CoV-2 seroprevalence in Russia are few. The study aimed to assess the SARS-CoV-2 seroprevalence in Arkhangelsk (Northwest Russia), in a year after the start of the pandemic, to evaluate the population adherence to non-pharmaceutical interventions (NPIs), and to investigate characteristics associated with COVID-19 seropositive status. Methods - We conducted a SARS-CoV-2 seroprevalence study between 24 February and 30 June 2021 involving 1332 adults aged 40–74 years. Logistic regression models were fit to identify factors associated with seropositive status and with adherence to NPIs. Results - Less than half (48.9%) of study participants adhered all recommended NPIs. Male sex (odds ratio [OR] 1.7, 95% confidence intervals [CI] 1.3; 2.3), regular employment (OR 1.8, 95% CI 1.3; 2.5) and low confidence in the efficiency of the NPIs (OR 1.9, 95% CI 1.5; 2.5) were associated with low adherence to internationally recommended NPIs. The SARS-CoV-2 seroprevalence rate was 65.1% (95% CI: 62.5; 67.6) and increased to 73.0% (95% CI: 67.1; 85.7) after adjustment for test performance. Regular employment (OR 2.0, 95% CI 1.5; 2.8) and current smoking (OR 0.4, 95% CI 0.2; 0.5) were associated with being seropositive due to the infection. Conclusions - Two third of the study population were seropositive in a year after the onset of the pandemic in Arkhangelsk. Individuals with infection-acquired immunity were more likely to have regular work and less likely to be smokers. The adherence to NPIs was not found associated with getting the virus during the first year of the pandemic

Untreated hypertension in Russian 35-69 year olds – a cross-sectional study

Background - The Russian Federation has among the highest rates of cardiovascular disease (CVD) in the world and a high rate of untreated hypertension remains an important risk factor. Understanding who is at greatest risk is important to inform approaches to primary prevention. Methods - 2,353 hypertensive 35–69 year olds were selected from a population-based study, Know Your Heart, conducted in Arkhangelsk and Novosibirsk, Russian Federation, 2015–2018. The associations between untreated hypertension and a range of co-variates related to socio-demographics, health, and health behaviours were examined. Results - The age-standardised prevalence of untreated hypertension was 51.1% (95% CI 47.8–54.5) in males, 28.8% (25.4–32.5) in females, and 40.0% (37.5–42.5) overall. The factors associated with untreated hypertension relative to treated hypertension were younger ages, self-rated general health as very good-excellent, not being obese, no history of CVD events, no evidence of diabetes or chronic kidney disease, and not seeing a primary care doctor in the past year as well as problem drinking for women and working full time, lower education, and smoking for men. Conclusion - The study found relatively high prevalence of untreated hypertension, especially, in men. Recent initiatives to strengthen primary care provision and implementation of a general health check programme (dispansarisation) are promising, although further studies should evaluate other, potentially more effective strategies tailored to the particular circumstances of this population

Adherence to antihypertensive medication in Russia: A scoping review of studies on levels, determinants and intervention strategies published between 2000 and 2017

Source at https://doi.org/10.1186/s13690-019-0366-9.Background - Arterial hypertension (HT) is common in the Russian adult population, with half of affected individuals inadequately controlled. Low adherence to medication seems likely to be a factor. We report a scoping review of studies on adherence to antihypertensive therapy (AHT) in Russia to determine the extent of research undertaken, the frequency of adherence among adults diagnosed with HT, methodologies used in the studies, and their ability to describe determinants of adherence. Methods - A scoping review of published studies that have assessed adherence to AHT in Russian HT patients searched the main Russian and international electronic databases eLIBRARY.ru, Russian Medicine, Embase, MEDLINE for full-text reports published in the Russian language between 2000 and 2017. The last search was on November 28, 2017. Among 520 reports identified, 31 were included in the review. Results - Eighteen studies assessed adherence using the 4-item Morisky Medication Adherence Scale (MMAS-4); others used bespoke questionnaires or pill counts. 25 studies assessed levels of adherence, 11 examined its determinants, and 18 examined intervention strategies. The proportion of “adherent” patients varied from 11 to 44% using the MMAS-4, from 23 to 74% when using bespoke questionnaires, and from 5 to 43% when using pill counts. Adherence was associated with sociodemographic factors, access to free drugs provided through the Medicine Assistance Scheme (MAS), use of home blood pressure (BP) monitoring, anxiety, and comorbidity. There was no evidence that adherence was associated with income or physical activity. Evidence of an association between MAS, grade of HT, or experience of hypertensive crisis was inconclusive. Various methods to improve adherence were studied including patient education (improved from 1.8 to 3.9 points, p = 0.0002 or 2.80 to 3.79 points, p < 0.0001 measured by the MMAS-4), telephone reminders (p < 0.0001), training in home BP monitoring (p < 0.05), and use of fixed-dose combinations (p < 0.05). Conclusions - The main determinants of adherence to AHT are sociodemographic characteristics, the severity of HT, and presence of comorbidity. Patient education and use of fixed-dose combinations of drugs were identified as most important for improving adherence. Most studies assessing adherence use self-reported methods so there is a need for greater use of objective methods

Understanding the role of physicians within the managerial structure of Russian hospitals.

This article examines the role of physicians within the managerial structure of Russian hospitals. A comparative qualitative methodology with a structured assessment framework is used to conduct case studies that allow for international comparison. The research is exploratory in nature and comprises 63 individual interviews and 49 focus groups with key informants in 15 hospitals, complemented by document analysis. The material was collected between February and April 2017 in five different regions of the Russian Federation. The results reveal three major problems of hospital management in the Russian Federation. First, hospitals exhibit a leaky system of coordination with a lack of structures for horizontal exchange of information within the hospitals (meso-level). Second, at the macro-level, the governance system includes implementation gaps, lacking mechanisms for coordination between hospitals that may reinforce existing inequalities in service provision. Third, there is little evidence of a learning culture, and consequently, a risk that the same mistakes could be made repeatedly. We argue for a new approach to governing hospitals that can guide implementation of structures and processes that allow systematic and coherent coordination within and among Russian hospitals, based on modern approaches to accountability and organisational learning

Pre-hospital delays among patients with acute coronary syndrome in the Russian Federation: a multicentre prospective observational cohort study (the AMIR Study)

Objective: This study aimed to describe total pre-hospital delays (symptom onset to admission), patient delays (symptom onset to calling for help), and transport delays (calling for help to admission) experienced by patients with acute coronary syndrome (ACS) in Russia and identify factors associated with longer delays. Methods: A prospective observational cohort study of ACS patients with myocardial infarction recruited in hospitals providing percutaneous coronary intervention (PCI) and those that do not (non-PCI) in 13 regions and at multiple levels of the health system in Russia. Data were collected on pre-hospital delays between symptom onset and admission to the hospital providing definitive treatment, divided into patient delay (time between symptom onset and calling for help) and transport delay (time between calling for help and admission). Results: Of 902 patients, 701 (77.7%) had full data on pre-hospital delays. The median total pre-hospital delay in our study was 5.1 h, the median patient delay was 1.5 h, and the median transport delay was 2.1 h. Patient delays did not differ by age and sex, although having an ST-elevation myocardial infarction (STEMI) and certain symptom presentations, including severe pain, reduced delays. Transport delays were markedly reduced in those transported by emergency medical services (EMS) and taken directly to the hospital of definitive treatment (rather than to one closer but unable to offer PCI). Although transport delays were reduced in those using EMS, just half of the patients using EMS had a transport delay of &amp;lt;2 h (first medical contact to admission). Among all patients taken directly to the hospital by EMS, 70% were STEMI patients. Of these STEMI patients, 78% had a transport delay of 2 h or more. Among these patients, only 16.0% received thrombolysis in the ambulance. As expected, regional differences were apparent with all types of delay, with the greatest variation found in transport delays. Conclusion: Delays are currently longer than the European Society of Cardiology guidelines for STEMI patients and other severe cases. Reducing patient delays will reduce overall delays. Transport delays are inevitable in many regions of Russia, but better triage of patients, increased use of EMS, and early thrombolysis in EMS, particularly for STEMI patients facing excessive transport delays, will reduce delays and buy time before PCI

Primary care use and cardiovascular disease risk in Russian 40-69 year olds: a cross-sectional study.

BACKGROUND: The Russian Federation has very high cardiovascular disease (CVD) mortality rates compared with countries of similar economic development. This cross-sectional study compares the characteristics of CVD-free participants with and without recent primary care contact to ascertain their CVD risk and health status. METHODS: A total of 2774 participants aged 40-69 years with no self-reported CVD history were selected from a population-based study conducted in Arkhangelsk and Novosibirsk, Russian Federation, 2015-2018. A range of co-variates related to socio-demographics, health and health behaviours were included. Recent primary care contact was defined as seeing primary care doctor in the past year or having attended a general health check under the 2013 Dispansarisation programme. RESULTS: The proportion with no recent primary care contact was 32.3% (95% CI 29.7% to 35.0%) in males, 16.3% (95% CI 14.6% to 18.2%) in females, and 23.1% (95% CI 21.6% to 24.7%) overall. In gender-specific age-adjusted analyses, no recent contact was also associated with low education, smoking, very good to excellent self-rated health, no chest pain, CVD 10-year SCORE risk 5+%, absence of hypertension control, absence of hypertension awareness and absence of care-intensive conditions. Among those with no contact: 37% current smokers, 34% with 5+% 10-year CVD risk, 32% untreated hypertension, 20% non-anginal chest pain, 18% problem drinkers, 14% uncontrolled hypertension and 9% Grade 1-2 angina. The proportion without general health check attendance was 54.6%. CONCLUSION: Primary care and community interventions would be required to proactively reach sections of 40-69 year olds currently not in contact with primary care services to reduce their CVD risk through diagnosis, treatment, lifestyle recommendations and active follow-up