Comparative analysis of the course and outcomes of a new coronavirus infection depending on the level of high-density lipoproteins in hospitalized patients with COVID-19

Aim of the study was to analyze the course and outcomes of a new coronavirus infection depending on the level of high-density lipoproteins in hospitalized patients with COVID-19. Material and methods. A retrospective analysis of the medical histories of 208 patients hospitalized with a diagnosis of COVID-19 was carried out. Depending on the level of high-density lipoproteins (HDL), patients were divided into 2 groups: group 1 – patients with «low» HDL < 0.83 mmol/l, group 2 – patients with «high» HDL ≥ 0.83 mmol/l. The relationship between HDL levels measured at the beginning of hospitalization and the severity of the course and outcomes of coronavirus infection was evaluated. The primary endpoint was nosocomial death, secondary points: the development of complications of coronavirus infection, the duration of hospitalization, the duration of fever, the duration of stay in the intensive care unit (ICU). Results. In hospitalized patients with COVID-19, lipid profile disorders were observed in the form of a decrease in HDL (<1.0 mmol/l) in 62 % of cases. A «low» HDL level (<0.83 mmol/l) was associated with a more unfavorable course of coronavirus infection in the hospital in the form of a larger volume of lung damage both at admission and at discharge (40 % [32; 54] vs. 32 % [24; 40], p < 0.001 and 40 % [28; 52] vs. 32 % [28; 44] p = 0.018, respectively), the development of complications such as «cytokine storm» (17 % vs. 22 %, p = 0.03), acute kidney injury (10 % vs. 16 %, p = 0.007). When analyzing secondary points, it was found that in patients of group 1 («low» HDL level), in comparison with patients of group 2 («high» level) the fever period was longer (10 [7; 12] days vs. 8.5 [7; 10] days, p = 0.04), the period of stay in the ICU (0 [0; 1] days vs. 0 [0; 0] days, p = 0.03) and the duration of hospitalization was longer (9 [7; 12] days vs. 8,6 [7; 12] days, p < 0.001).The primary endpoint – hospital mortality was statistically significantly higher in patients with initially reduced HDL levels (<0.83 mmol/l) (13 % vs. 8 %, p = 0.013). Conclusions. In hospitalized patients, the level of HDL <0.83 mmol/l at the beginning of hospitalization was associated with a more severe course of coronavirus infection in the subsequent and an increase in hospital mortality

The comparative analysis of efficiency of treatment of patients with stable stenocardia at a combination to gastroduodenal pathology

Eradikatsionny therapy in an algorithm of treatment of сoronary heart disease patients with the gastroduodenal pathology provides stabilization of a clinical picture, at the same time, promotes achievement of morphological remission of gastroduodenal pathology.Эрадикационная терапия в алгоритме лечения больных ИБС с гастродуоденальной патологией обеспечивает стабилизацию клинической картины, при этом способствует достижению стойкой морфологической ремиссии гастродуоденальной патологии

Impact of optimal therapy for noncommunicable diseases on the course and outcome of COVID-19 inpatients

Aim. To carry out a comparative analysis of the impact of optimal and suboptimal therapy for noncommunicable diseases (NCDs) at the prehospital stage on the severity and outcomes of coronavirus disease 2019 (COVID-19).Material and methods. The study included 158 patients hospitalized with a diagnosis of COVID-19 and having one or more concomitant NCDs. Patients were divided into two groups depending on the quality of initial therapy for NCDs: group 1 — patients receiving treatment that does not meet modern clinical guidelines, taking drugs not regularly or not taking them at all (n=100; 63%), and group 2 — patients receiving treatment in accordance with current clinical guidelines, taking regularly prescribed therapy (n=58; 37%). The primary endpoint was inhospital death, while secondary endpoints — duration of fever, length of intensive care unit (ICU) stay, length of hospital stay.Results. Inhospital mortality was significantly higher in the 1st group of patients compared with the 2nd group (18,0% vs 1,7%, p=0,002). Analysis of secondary endpoints revealed that patients of the 1st group (nonoptimal therapy), in comparison with the 2nd group (optimal therapy), had significantly longer period of fever (10 [7; 12] vs 9 [7; 10] days, p=0,03), longer ICU (0 [0; 3] vs 0 [0; 0] days, p&lt;0,001) and hospital stay (10 [8; 14] vs 8 [7; 11] days, p=0,001).Conclusion. Patients who received standard NCD therapy before admission to the infectious disease hospital, in accordance with current clinical guidelines and who regularly take drugs, have a more favorable course of COVID-19 at the hospital stage and a lower inhospital mortality rate than patients with suboptimal therapy who are not adherent to treatment or not receiving drugs, but having indications for taking them

ECONOMIC BENEFITS OF LEFT VENTRICULAR HYPERTROPHY REGRESSION IN PATIENTS WITH ARTERIAL HYPERTENSION

Aim. To evaluate by modelling the economic benefits of left ventricular hypertrophy (LVH) regression in patients with arterial hypertension (HT) due to therapy with fixed combination of valsartan/amlodipine.  Material and methods. 20 patients (15 females and 5 males, aged 18 to 70 years) with essential HT accompanied by metabolic syndrome with a history of previous ineffective antihypertensive therapy were included into the study. All patients were treated with fixed combination of amlodipine/valsartan in doses of 5/160 and 10/160 mg depending on blood pressure (BP) level. Treatment duration was 24 weeks. Changes in BP level, LVH regression were assessed. Economic evaluation was performed on the basis of modelling with the specialized software Decision Tree 4.xla. Results. Effect of fixed amlodipine/valsartan combination therapy on LVH was used to estimate treatment effectiveness and to build the model. Patients were distributed according to left ventricular (LV) mass (at baseline and after 24 weeks of therapy). Significant decrease in LV mass from 205.8±50.4 to 181.9±45.1 g (p&lt;0.05) was revealed. The model took into account economic and frequency factors for 10 year prognosis: this therapy prevents 36 deaths, 6 strokes, 24 myocardial infarction per 1000 patients. Absence of need in treatment of these prevented events can save 2 516 772.42 RUR for every 1 000 patients. It would reduce the total costs per patient during 10 years. Conclusion. Treatment with amlodipine/valsartan single pill combination has not only clinical advantages, but also pharmacoeconomic benefits. This combination reduces risk of acute myocardial infarction and death more effectively. Treatment with fixed valsartan/amlodipine combination saves maximum years of life with less cost during 10 years. Despite of higher pharmacotherapy costs, fixed valsartan/amlodipine combination reduces total costs due to prevention of fatal and nonfatal cardiovascular events

Empagliflozin in patients hospitalized for acute decompensated heart failure: an expert resolution on the discussion of the EMPULSE trial

An online expert meeting held on November 17, 2021 reviewed the results of the randomized, double-blind, multinational, parallel-group EMPULSE trial, evaluating the clinical benefit and safety of the sodium-glucose co-transporter-2 inhibitor (SGLT2i) empagliflozin compared with placebo in patients hospitalized with acute decompensated heart failure (ADHF). Patients were included in the study regardless of ejection fraction (EF) and the presence of diabetes and randomized during hospitalization after stabilization. In addition, the EMPULSE trial used a composite result analyzed using a stratified benefit ratio — Win Ratio analysis. There is evidence of clinical benefit of empagliflozin in hospitalized patients with preserved and reduced LVEF, as well as in patients with newly diagnosed ADHF or with acute decompensation of chronic heart failure (CHF) compared with placebo, regardless of type 2 diabetes presence. The importance of the favorable results of the EMPULSE trial and its significance for clinical practice, which implies the early administration of empagliflozin for inpatients, is noted. A number of proposals have been adopted to accelerate the introduction of empagliflozin into clinical practice for patients with ADHF

Approaches to the therapy of heart failure with reduced ejection fraction. Resolution of an online meeting of the Volga Federal District experts

At an online meeting of experts held on May 14, 2021 additional research results on a sodium-glucose co-transporter-2 (SGLT2) inhibitor empagliflozin in patients with heart failure with reduced ejection fraction were considered. According to the data from the EMPEROR-Reduced international study, cardiovascular and renal effects of empagliflozin therapy in patients with and without type 2 diabetes (T2D) were analyzed. A number of proposals and recommendations was accepted regarding the further study of cardiovascular and renal effects of empagliflozin and its use in clinical practice in patients with heart failure, regardless of the T2D presence

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

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period

IVABRADINE OUTSIDE THE CLINICAL GUIDELINES: INTEREST OF A PRACTITIONER

The article is focused on the data concerning the influence of ivabradine on myocardial electrophysiology in experimental and clinical studies. It is shown that ivabradine decreases ventricular rate in chronic atrial fibrillation, and prevents the paroxysms of atrial fibrillation. In myocardial hypertrophy patients or in serious chamber dilation, ivabradine shows moderate antiarrhythmic effect on ventricular arrhythmias