Clinical Features and the NT-proBNP Marker in Patients with Chronic Heart Failure in the Setting of Atrial Fibrillation and Chronic Obstructive Pulmonary Disease

Aim: To determine the clinical features and analyse the concentration of the heart failure (HF) marker in patients with atrial fi brillation (AF) and chronic obstructive pulmonary disease (COPD).Materials and methods: 120 patients were divided into the following groups: 1) experimental group including patients with chronic heart failure (CHF), AF and COPD (n = 29); 2) comparison group 1 including patients with COPD, but without cardiovascular diseases (CVD) (n = 28); 3) comparison group 2 consisting of patients with CHF and COPD, but without AF (n = 30); 4) comparison group 3 comprising patients with CHF and AF, but without COPD (n = 33). Clinical symptoms and tolerance to physical load were assessed for all patients with CHF using the clinical condition scale (CCS) and the 6 Minute Walk Test (6MWT), respectively. The severity of dyspnoea was assessed (mMRC scale) in the groups of patients with COPD. The concentration of NT-proBNP was analysed using a Biomedica NT-proBNP reagent pack (SK-1204).Results: A comparative analysis of the CHF clinical manifestations (according to CCS) in the study groups showed higher median values in the group of patients with CHF, AF and COPD, as compared to the same indicator in patients with CHF and AF, but without COPD (p < 0.001). An intergroup analysis of the dyspnoea symptom using the mMRC scale showed the lowest degree of dyspnoea in the group with COPD and without CVD, which signifi cantly differed from the same indicator in patients with CHF and COPD, but without AF (p = 0.015). The 6MWT results did not reveal signifi cant differences between the groups (p = 0.017). In assessing the level of the HF marker, higher concentrations of NT-proBNP were found in the group of patients with CHF, AF and COPD, which exceeded its concentration in patients with CHF and COPD, but without AF (p = 0.0003), as well as in patients with CHF and AF, but without COPD (p = 0.01).Conclusion: 1. Due to the presence of chronic bronchial obstructive syndrome, higher severity of clinical HF symptoms was established in patients with CHF, AF and COPD – as compared to the group including patients with CHF and AF, but without COPD. 2. A statistically signifi cant higher level of NT-proBNP was determined in patients with CHF, AF and COPD, which is associated with the presence of hemodynamic load on both ventricles of the heart under the mutual infl uence of AF and chronic bronchial obstruction on the hemodynamics of the pulmonary circulation

Clinical traits of chronic heart failure in patients with arterial hypertension and senile asthenia syndrome: an observational cross-sectional study

Background. A steady population aging and high incidence of arterial hypertension (AH) lead to a stable increase in chronic heart failure (CHF). The rate of senile asthenia syndrome (SAS) rises in people aged over 80 years and becomes an independent factor of cardiovascular complications.Objectives. The identification of risk factors (RF), comorbidity and clinical symptoms in elderly patients with CHF, AH and SAS.Methods. The study covered 161 AH and CHF patients aged over 80 years. Cohort 1 contained “frailty” patients with AH, CHF and SAS, cohort 2 — “strong” patients with AH, CHF but no SAS. RF, concomitant pathology, clinical symptoms and six-minute walk test were evaluated in all patients. Statistical analyses were performed with Statistica 12.0.Results. Cohort 1 had a higher incidence of atrial fibrillation (AF) (p = 0.001) and chronic kidney disease (CKD) (p = 0.036) compared to cohort 2. Frailty women revealed a higher AF incidence vs. frailty men (p = 0.0002). No-SAS patients had statistically significantly higher body mass index (BMI) (p = 0.047) and obese proportion (by 13.8%). Cohort 1 contained a significantly higher CHF FC III (functional class III), and cohort 2 — CHF FC II rate (p = 0.041). CHF FC III was significantly more frequent in frailty women, and CHF FC II — in frailty men (p = 0.018). Cohort 1 had higher clinical severity scores and a lower exercise tolerance compared to cohort 2 (p < 0.001).Conclusion. Patients with CHF and SAS had a more frequent comorbidity with AF and CKD, greater number of comorbidities and a significantly higher CHF FC III rate, especially in women. Frailty patients showed a greater CHF severity and lower exercise tolerance compared to noSAS individuals

STUDY OF THE PARAMETERS OF TOLERABILITY AND ADHERENCE TO THERAPY IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ARTERIAL HYPERTENSION ON THE BACKGROUND OF TREATMENT WITH FIXED COMBINATION OF RAMIPRIL AND AMLODIPINE (ACCORDING TO THE RESULTS OF OBSERVATIONAL STUDY "GRANAT-2")

Working group of the “GRANAT-2” study: Tula - Trubitsyn G.I., Ivanov Yu.V., Mirenkova O.K., Eskova R.A., Simonova R.P., Milon M.E., Telegina E.V., Kuznetsov A.M., Zhukova N.A., Zainullina I.K.; Rostov-on-Don - Budanov O.V., London E.M., Minosyan L.V., Nedashkovskaya N.G., Ter-Ananyants Ye.A.; Tomsk - Proskokova I.Yu., Permyakova O.V., Politova L.V., Maneeva I.D., Ivanova S.Yu.; Nizhny Novgorod - Larina O.V., Pokrovskaya I.N., Patselt E.A.; Moscow - Sladkova T.A., Zelenova Т.V. Aim. To study the tolerability and adherence to antihypertensive therapy in patients with hypertension and chronic obstructive pulmonary disease (COPD) using the fixed combination of ramipril and amlodipine in the observational program for patients with arterial hypertension and COPD (GRANAT-2). Material and methods. Patients with hypertension and COPD (n=52) with all inclusion criteria and without exclusion criteria who signed informed consent to participate in the GRANAT-2 program were included into the study. The use of a fixed combination of ramipril and amlodipine was recommended in all patients. The doses were determined by the treating physicians in accordance with the official drug instruction. The patients had 4 visits, and the duration of the study was 5 months. The Morisky-Green test was used to assess an adherence of patients to treatment. Assessments of blood pressure, adverse events were performed at all visits. Results. 50 of 52 patients completed the study: 45 patients used the studied fixed combination in the recommended doses, and 5 patients used other antihypertensive drugs, 2 patients withdrew from the study. Systolic blood pressure after 1 month of treatment decreased by an average of 20 mm Hg from the baseline, and diastolic blood pressure – by 10 mmHg. These rates after 5 months of therapy were 29 mm Hg and 15 mm Hg, respectively. Target blood pressure level was achieved in all patients. Increase in adherence of patients to treatment (according to the Morisky-Green test from 21.1% to 65.1%) was found. 2 cases of adverse events (dry cough) were registered. The discrepancy in adherence assessment was revealed between the results from the Morisky-Green test and the data from program case report forms. Conclusion. Regular patient visits to the doctor and the rapid achievement of an antihypertensive effect with good tolerability of a fixed combination of ramipril and amlodipine contributed to the increase in adherence of patients to treatment. Undesirable effects of the drug therapy are significant, but not leading factors that have a negative impact on the patient adherence to treatment

Pharmacoepidemiological analysis of routine management of heart failure patients in the Russian Federation. Part II

Aim. To assess the healthcare system costs for the management of patients with heart failure (HF) based on a retrospective analysis of primary medical documentation.Material and methods. We performed the analysis of outpatient records of 1000 patients, followed up for 1 year by a general practitioner or cardiologist in ambulatory clinic in 7 Russian regions. The assessment of the HF socioeconomic burden was carried out from the perspective of the state. A bottom-up approach was applied to the cost analysis. To calculate the average costs per patient per year, the costs for each patient were calculated, followed by estimation for the entire cohort. Direct costs (medical: outpatient care, inpatient care, drug therapy; nonmedical: disability pensions and temporary disability) and indirect costs (loss of gross domestic product) were estimated.Results. It was shown that the average cost of managing 1 HF patient is RUB 160338 per year. The cost of drug therapy varied significantly depending on the source of funding. So, the total therapy cost was about RUB 90000 per year, while within the drug assistance programs — about RUB 7000 per year. Thus, the proportion of drug therapy in cost pattern per patient from the state’s perspective was only 4,7%, while the maximum costs were for inpatient care (45,5%), stay in intensive care units (16,4%) and disability payments (21,6%). The direct costs for HF therapy, with the exception of drug therapy (examination, inpatient and outpatient treatment), averages RUB 108291 per year. The total direct nonmedical and indirect costs per HF patient per year were about RUB 44519 per year. It should be noted that the rehabilitation costs were not included in the calculation.Conclusion. Taking into account the significant burden of HF on the Russian healthcare system, the growing costs of healthcare and the increase in life expectancy, prevention and treatment of HF should be improved. The development of a HF centers’ network, creating a seamless system of HF care, as well as improving the availability of medication therapy and the inpatient management of patients can improve the healthcare quality for HF patients in Russia

Клинический регистр по изучению популяции пАциентов с выявленным МультифокальныМ Атеросклерозом на территории Российской Федерации и стран Евразии – КАММА

HighlightsDeveloping international registry that would unify different patient populations not represented in other registries and studies, and include patients with both manifested and subclinical atherosclerosis, is crucial for cardiovascular field. The collected data can be used in national guidelines, teaching and learning guides, and in clinical practice. AbstractMultifocal atherosclerosis (MFA) is one of the key issues in modern medicine. Several vascular beds are involved in the pathological process in every fifth patient with detected atherosclerosis. Moreover, patients with MFA have high risk of ischemic events, lower quality of life, shorter life expectancy and disability. “The Eurasian Association of Internal medicine” proposed to create a registry on real clinical practice in order to collect data on the frequency, detection methods, clinical course, risk factors and outcomes of patients with MFA in specialized centers in Russia and Commonwealth of Independent States (Republic of Kazakhstan, Republic of Uzbekistan, Republic of Belarus).Основные положенияСоздание локального международного регистра, объединяющего различные популяции пациентов, не представленных в других завершенных регистрах и исследованиях, а также включающего больных не только с манифестирующей, но и субклинической стадией атеросклеротического процесса, представляет научный и практический интерес. Полученные данные могут быть использованы при написании национальных рекомендаций, учебно-методических пособий, а также применимы в клинической практике. АбстрактМультифокальный атеросклероз (МФА) – одна из ключевых проблем современной медицины. Известно, что у каждого пятого пациента с выявленным атеросклеротическим поражением в патологическом процессе задействовано несколько сосудистых бассейнов. Кроме того, больные МФА подвержены крайне высоким рискам ишемических событий, снижению качества жизни, ее продолжительности и инвалидизации. Евразийской ассоциацией терапевтов предложено создать регистр реальной клинической практики с целью сбора данных о встречаемости, методах выявления, клиническом течении, факторах риска и исходах пациентов с МФА на базе центров России и стран СНГ (Республики Казахстан, Узбекистан, Беларусь)

Rehabilitation after COVID-19. Resolution of the International Expert Council of the Eurasian Association of Therapists and the Russian Society of Cardiology

By the middle of 2021, the official global number of coronavirus disease 2019 (COVID-19) patients was close to 230 million, but the number accounting for asymptomatic patients was much higher. Consequences and rehabilitation after COVID-19 are of particular interest and raise many controversial and unresolved issues. On May 18, 2021, the Eurasian Association of Therapists organized an international panel of experts to analyze challenges associated with the post-COVID-19 period. This panel aimed to develop approaches to identify gaps in the discussed issues. This interdisciplinary team of leading experts reviewed the current literature and presented their data to formulate practical guidance on management of patients after COVID-19. The panel of experts also presented recommendations on how to implement the gained knowledge into health care practices

2020 Clinical practice guidelines for Myocarditis in adults

Russian Society of Cardiology (RSC)With the participation: Eurasian Association of Therapists (EUAT), Society of Specialists in Heart Failure (OSSN), Russian Scientific Medical Society of Therapists (RNMOT), Russian Society of Pathologists, Russian Society of Radiologists and Radiologists (RSR)Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federatio