DOCTOR INERTNESS AS A FACTOR DISTURBING EFFECTIVE TREATMENT OF CARDIOVASCULAR DISEASES

Aim. To evaluate factors contributing to development of inertness in doctors of the primary care which treat and follow-up patients with cardiovascular diseases (CVD).Material and methods. The anonymous poll was carried out among 184 primary care physicians. The questionnaire included information about sex, age, time and conditions of work, established stereotype of practice, knowledge of current guidelines on CVD treatment. The study was one-stage with usage of questionnaire.Results. High prevalence of inertness was observed among physicians. Only 43 (26,4%) of doctors had active stereotypes of practice, which prevent inertness. These physicians have more often post-graduate specialization, read international guidelines, foreign and web-journals, evaluate higher non-drug approaches to prevention and therapy and they more often initiate long-term patient observation.Conclusion. Inertness is common behavior feature among primary care. The main reasons of this inertness are insufficient knowledge of modern guidelines on CVD treatment and lack of skills on its practical usage

EMOTIONAL BURNOUT SYNDROME: EFFECT ON CLINICAL INERTIA AND MEDICAL PRACTICE STEREOTYPES

Aim. To estimate the prevalence of burnout in primary care physicians and its influence on medical practice stereotypes and on clinical inertia.Material and Methods. The anonymous single-stage poll was carried out among 184 primary care physicians. The questionnaire included information about sex, age, period and conditions of work, established stereotypes of practices. Burnout was evaluated by Russian analog of Maslach Burnout Inventory. It was defined in high level of emotional exhaustion and depersonalization and low level of personal accomplishment 11 questions were developed to reveal of suboptimal medical practice (for example, “I do not discuss treatment options with patient and do not give full answers to his questions” or “I make diagnostic and treatment errors despite of my professional knowledge and inexperience”).Results. The burnout syndrome (or extreme grade of emotional burnout) occurs in 13,1% and high level of emotional burnout – in 49,7% of primary care physicians. Features of suboptimal medical practice are usually found in 24,2% of primary care physicians at least monthly. It expresses more often in improper attitude to paqtients and their problems associated with a disease. Thus, burnout contributes to improper attitude to patients. Professional burnout affects established work stereotypes and can promote development of physician’s clinical inertia.Conclusion. As the burnout is common among primary care physicians, an adequate monitoring and prevention of this state is necessary in medical labour management

EMOTIONAL BURNOUT SYNDROME: EFFECT ON CLINICAL INERTIA AND MEDICAL PRACTICE STEREOTYPES

Aim. To estimate the prevalence of burnout in primary care physicians and its influence on medical practice stereotypes and on clinical inertia.Material and Methods. The anonymous single-stage poll was carried out among 184 primary care physicians. The questionnaire included information about sex, age, period and conditions of work, established stereotypes of practices. Burnout was evaluated by Russian analog of Maslach Burnout Inventory. It was defined in high level of emotional exhaustion and depersonalization and low level of personal accomplishment 11 questions were developed to reveal of suboptimal medical practice (for example, “I do not discuss treatment options with patient and do not give full answers to his questions” or “I make diagnostic and treatment errors despite of my professional knowledge and inexperience”).Results. The burnout syndrome (or extreme grade of emotional burnout) occurs in 13,1% and high level of emotional burnout – in 49,7% of primary care physicians. Features of suboptimal medical practice are usually found in 24,2% of primary care physicians at least monthly. It expresses more often in improper attitude to paqtients and their problems associated with a disease. Thus, burnout contributes to improper attitude to patients. Professional burnout affects established work stereotypes and can promote development of physician’s clinical inertia.Conclusion. As the burnout is common among primary care physicians, an adequate monitoring and prevention of this state is necessary in medical labour management.</p

AGE-DEPENDENT ASPECTS OF ACUTE CORONARY HEART DISEASE INCIDENCE RATE AND MORTALITY IN MEN AND WOMEN

Aim. To study gender and age characteristics of incidence rate, mortality and lethality in acute coronary heart disease (ACHD).Material and Methods. Analysis of the ACHD (ICD-10 codes: I21.0-I22.9, I20.0, I24) morbidity, mortality and lethality, depending on sex and age was performed in the population (n=285 736; 46% men) of several city administrative districts of Voronezh, Ryazan and Khanty-Mansiysk. Morbidity, mortality and lethality were calculated on the basis of medical documentation as well as cases identified by the study protocol.Results. The ACHD morbidity and mortality in men were 1.99 and 1.79 times higher (p&lt;0,001), respectively, than these in women. The studied parameters increase with age, reaching a maximum in 50-59 y.o., have a plateau in 60-79 y.o. and then they decrease. Morbidity and mortality in women increase with age, but reach a maximum in 70-79 y.o., being comparable with the male level, and then exceed it in ≥80 y.o. Age curve of lethality in men has J-alike shape with minimum in patients of 50-79 y.o. Women have a line age curve with minimum in patients of &lt;50 y.o.Conclusion. The population of ACHD patients should be considered according to both the sex and age: &lt;50, 50-79 and ≥80 y.o. Every of these population group has special epidemiological characteristics

SUDDEN CARDIAC DEATH IN PATIENTS WITH CORONARY HEART DISEASE: RESULTS OF THE RUSSIAN MULTI-CENTRE EPIDEMIOLOGICAL STUDY OF MORTALITY, MORBIDITY, AND DIAGNOSTICS AND TREATMENT QUALITY IN ACUTE CHD (RESONANCE)

The study was aimed at assessing the incidence of sudden cardiac death (SCD) in patients with coronary heart disease (CHD) and evaluating the quality of SCD diagnostics and statistical registration in medical institutions (MI). In the population of 285736 patients with CHD (76,4% aged 18 years or older; 46% men), the incidence of SCD cases registered in MIs was compared to the study algorithm-based incidence of SCD. The latter was as high as 156 per 100 000 in men and 72 per 100 000 in women, which was 2,3 and 2,8 times higher, respectively, than the MI-registered levels (р&lt;0,001). MI-based diagnostics and/or registration missed 55,6% and 66,5% of the SCD cases in men and women with CHD, respectively. The two main explanations were inadequate diagnostic search at death cause identification (45,4%) and mistakes made at completing medical documents (55,6%). Therefore, every second SCD case in men with CHD and two-thirds of SCD cases in women with CHD are not identified by MIs, which results in under-estimation of SCD incidence

HYPERURICEMIA AND ITS CORRELATES IN THE RUSSIAN POPULATION (RESULTS OF ESSE-RF EPIDEMIOLOGICAL STUDY)

Aim. To study the prevalence of hyperuricemia in the Russian regions, depending on the climatic, geographical, socio-demographic characteristics and some cardiometabolic risk factors.Material and methods. Data from the ESSE-RF study from 10 regions of theRussian Federationare presented. All study participants were examined according to a uniform protocol. Measurements were standardized, biochemical tests were carried out in three Federal centers using the same methodology. The study was approved by independent Ethics committees, and all participants signed informed consent.Results. The prevalence of hyperuricemia was 16.8% (25.3% in men and 11.3% in women; p&lt;0.0001). Hyperuricemia incidence increases with age, does not depend on education, significantly associates with place of residence, elevated blood pressure, obesity and abdominal obesity, alcohol consumption and diuretics taking. After adjustment for all factors included in the regression analysis, prevalence of hyperuricemia in the Ivanovo Region is 1.4 times higher than this in the reference region (Tyumen), while prevalence of hyperuricemia in the Samara Region and theRepublicofNorth Ossetia-Alaniais 30% and 40 % lower.Conclusion. Prevalence of hyperuricemia inRussiais defined; regions with the highest and lowest prevalence are identified. Associations of hyperuricemia with some social and demographic characteristics as well as cardiovascular risk factors are revealed.</p

ARTERIAL HYPERTENSION AMONG INDIVIDUALS OF 25–64 YEARS OLD: PREVALENCE, AWARENESS, TREATMENT AND CONTROL. BY THE DATA FROM ECCD

Aim. To study prevalence of arterial hypertension (AH), mean values of systolic and diastolic blood pressure (SBP, DBP), awareness of patients about their disease, medication consumption (MC) and efficacy of treatment in several regions of Russia.Material and methods. Representative selections were made in 9 regions of Russia: men (n=5563), women (n=9737) of 25–64 y.o., studied in 2012–2013 with the response 80%. Systematic stratified multilevel random selection was formed with localilty criteria (Kisch method). The Questionnaire on the presence of AH included: awareness of the patient about his disease, drug intake. BP measurement was performed on the right arm by automatic tonometer Omron in sitting position after 5 minutes resting. The mean value of two measurements was used. BP defined as SBP ≥140 mmHg, DBP ≥90 mmHg, or if the patient had taken antihypertensive therapy. Efficacy of treatment — the part of patients (in %) who reached target BP. Control group — part of patients (in %) with BP &lt;140/90 mmHg. Statistic data calculation was done with computer-based statistic software — SAS with standardising by age stratification of Europe.Results. Mean SBP and DBP were 130,7±0,1 mmHg and 81,6±0,1 mmHg respectively. Prevalence of AH — 44%, higher in men (p&lt;0,001). Prevalence of AH was higher in rural area citizens in men — 51,8% vs 47,5% (р&lt;0,02) and in women — 42,9% vs 40,2% (р&lt;0,05). Awareness was 67,5% in men, 78,9% in women. Medications were taken by 60,9% of women and 39,5% of men. Effectively treated were 53,5% of women and 41,4% of men. With the age the part of effectively treated decreases (p&lt;0,0005). BP is under control only in 1/3 of women and 14,4% of men.Conclusion. The role of AH as one of the main modifiable risk factors of cardiovascular diseases is proved, however it is depressing that the percent of controlled AH is low. BP control is the main task of outpatient surveillance at every local outpatient department, where now less than a half of those affected are being observed

THE PREVALENCE OF NON-INFECTIOUS DISEASES RISK FACTORS IN RUSSIAN POPULATION IN 2012-2013 YEARS. THE RESULTS OF ECVD-RF

In the frame of Multicenter observational study ECVD-RF (Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation) by the unique protocol the investigation of representative selections of adult population at the age of 25-64 y.o. of 11 regions RF (n=18305, including males, n=6919 and females n=11386): Volgograd, Vologda, Voronezh, Ivanovo, Kemerovo, Orenburg, Samara, Tomsk, Tyumen, Saint-Petersburg and Northern Osetia-Alania. The prevalence of the following risk factors (RF) of cardiovascular diseases is evaluated: high blood pressure — 33,8%, obesity — 29,7%, high total cholesterol — 57,6%, high glucose level or diabetes — 4,6%, smoking (tobacco consumption) — 25,7%, insufficient (low) level of physical activity — 38,8%, excessive salt consumption — 49,9% and insufficient vegetables and fruits consumption — 41,9%. Gender differences and an increase with the age of the parameters mentioned are described.The absence of a epidemiologic monitoring system at the Federal level leads to an impossibility of clear conclusions on the RF dynamics in Russian population. While comparing the ECVD-RF study with previous epidemiological studies we can just cautiously suppose the existence in 21st age of negative dynamics of one RF (obesity, dyslipidemia) and positive dynamics of the others (smoking)

Life quality of the Russian population by the data from ESSE-RF study

Life quality (LQ) is an integrated parameter of the health, applied for integral characterization of population health, and as the parameter of healthcare interventions effectiveness.Aim. To assess LQ in Russian population at the age 25-64 y. o. in general and in various socio-economical groups using EQ-5D, by the results of ESSE-RF (2012-2013) study.Material and methods. LQ was assessed on representative selections of inhabitants of 13 Russian Federation regions, aged 25-64 (males 8327, females 13497) with response 80%. LQ was assessed via international questionnaire EUROQOL — EQ-5D: 1) no decline; 2) mild decline; 3) significant decline; scoring also performed with visualanalogue scale (VAS). Integral LQ by EUROQOL performed with Shaw JW et al. method (ranging from 0,0 (death) to 1,0 (perfect health)).Result. EQ-5D index of Russian population was 0,87 with no gender difference. By the increase of the age LQ declines. Educational gradient of LQ was significant only in VAS (p&lt;0,05). Wealth level negatively associated with LQ. Most common (p&lt;0,0005) were disorders by the components pain/discomfort and anxiety/depression. Part of those with lower LQ among males is lesser than in females, by all 5 factors of the LQ, and in all educational states. Regional specifics of LQ by EQ-5D index: from 0,82 in Vladikcaucas to 0,95 in Orenburg (p&lt;0,0005). There was significant correlation of EQ-5D index with unemployment level (0,4) and consumer prices index (0,29) in regions.Conclusion. Monitoring of LQ is necessary condition for assessment of efficacy of population health improvement interventions, and the LQ values obtained will be useful as populational norms for health condition assessment in addition to morbidity and mortality factors

COMORBIDITIES OF ISCHEMIC HEART DISEASE WITH OTHER NON-COMMUNICABLE DISEASES IN ADULT POPULATION: AGE AND RISK FACTORS ASSOCIATION

Aim. To study the prevalence of ischemic heart disease as one of the most common cardiovascular disorders, together with arterial hypertension (AH), diabetes mellitus (DM) and liver diseases (LD) in adult (25-64 y.o.) population of selected RF regions, the variance of those with gender and age, and association of cardiovascular risk factors (FR).Material and methods. Into analysis we included the results of representative selections studies from 13 RF regions, studied according to the program of multicenter study ESSE-RF during the years 2012­2014; totally 21923 patients studied. Investigation included standard questioning, including anamnesis. For statistics we used applied software SAS.Results. In men the prevalence of IHD is associated with the growth of comorbidity from 0 in the age group 25-34 y. to 77% in the age 55-64 y., almost duplicating every decade. For women there is analogic tendency, less prominent. In men there are significant associations only with AH, which increases the risk of IHD 2,5 times, though in women together with AH the associations are significant for LD. Comorbidities with DM do not influence the prevalence of IHD in men and women. At the same time, any association with two diseases increases the risk of IHD &gt;304 times. The most negative is the association of all three diseases, with which IHD is 8,7 times more prevalent, than in their absence. Using multidimensional logistic regression after correction for the age and comorbidity in the patients with IHD of both genders, there are associations revealed of high density cholesterol lipoproteids (HDL) in blood and abdominal obesity. In men there are also positive associations with smoking and negative — with increased cholesterol.Conclusion. Comorbidities of IHD with AH, DM and LD in adult population are common, are associated with the general FR, are increasing with the age. Taking modern tendencies of population ageing, it is plausible to expect an increase of the prevalence of comorbidities, that requires a necessity of the healthcare services to these changes