ИНТЕГРАЦИЯ ИННОВАЦИОННЫХ ТЕХНОЛОГИЙ УПРАВЛЕНИЯ КАРДИОЛОГИЧЕСКОЙ СЛУЖБОЙ

Purpose. Improvement of a demographic situation in theKemerovoregion by development and introduction of innovative klinikoorganizational approaches in activity of cardiological service. Materials and methods. System and situation analysis, comprehensive approach, modeling. Results. The adverse demographic situation in economically developed industrial region of the Siberian federal District of (Kemerovoregion) is caused by mainly high mortality of the population from diseases of system of blood circulation (DSBC). Among operated factors the important role is allocated for system of rendering of specialized medical care, in particular: to ensuring continuity in prevention, treatment and rehabilitation of patients with DSBC; to close interaction of doctors of primary link (therapist, surgeon) and specialized institutions (cardiologist, кардиохирург); to creation of conditions for introduction of scientifi c and reasonable modern clinical approaches in practice. More than two decades in gKemerovothe integration model of cardiological service based on technology of «the closed cycle» with participation of establishments of health care of municipal and federal levels, medical science and education was formed. Conclusions. Availability of specialized hi-tech medical care to the population allowed to increase introduction of the concept of the general ideology, it is rational to use health care resources, to develop creative cardiology and to broadcast results of basic scientifi c researches in practice that affected improvement of a demographic situation in the region. In2010 incomparison with 2005 mortality from DSBC at able-bodied age in Kuzbass decreased by 33,7 %. Цель. Улучшение демографической ситуации в Кемеровской области путём разработки и внедрения инновационных клинико-организационных подходов в деятельности кардиологической службы. Материалы и методы. Системный и ситуационный анализ, комплексный подход, моделирование. Результаты. Неблагоприятная демографическая ситуация в экономически развитом промышленном регионе (Кемеровская область) обусловлена преимущественно высокой смертностью населения от болезней системы кровообращения (БСК). Важная роль отводится системе оказания специализированной медицинской помощи, в частности обеспечению преемственности в профилактике, лечении и реабилитации пациентов с БСК; тесному взаимодействию врачей первичного звена (терапевт, хирург) и специализированных учреждений (кардиолог, кардиохирург); созданию условий для внедрения научно обоснованных современных клинических подходов в практику. Более двух десятилетий в Кемерове формировалась интеграционная модель кардиологической службы, основанная на технологии «замкнутого цикла» с участием учреждений здравоохранения муниципального и федерального уровней, медицинской науки и образования. Выводы. Внедрение концепции общей идеологии позволило повысить доступность специализированной высокотехнологичной медицинской помощи для населения, рационально использовать ресурсы здравоохранения, развивать креативную кардиологию и транслировать результаты фундаментальных научных исследований в практику, что повлияло на улучшение демографической ситуации в регионе. В 2010 году по сравнению с 2005 годом смертность от БСК в трудоспособном возрасте в Кузбассе уменьшилась на 33,7 %.

New organisational strategies in acute coronary syndrome management

Aim. To assess the effectiveness of the new clinical and organisational strategies for specialised treatment of patients with acute coronary syndrome (ACS) — residents of a large industrial city. Material and methods. The object of the study was the system of specialised medical treatment of ACS patients in Kemerovo City. The study venue was the Kuznetsk Basin Cardiology Centre. The study period was 2004-2008, with 16752 ACS patients included. Results. Over the study period, the rates of urgent endovascular interventions increased by 16,8 times. The average time from admission to percutaneous coronary intervention decreased from 95 to 60 minutes. The inconsistencies in ACS diagnosis were registered in less than 9 % of the hospitalised patients. In-hospital case fatality among myocardial infarction patients decreased from 11,1 % to 9,7 % (р≤0,05). Conclusion. The adequate ACS management requires early admission of the patients with possible ACS to a specialised hospital; urgent cardiosurgery interventions in ACS individuals; and multi-level, risk-stratified strategies of invasive and conservative treatment, starting from the moment of admission to the specialised hospital

Potential of coronary angiography in the assessment of cardiac complication risk during non-cardiac interventions

Aim. To study the prevalence of coronary atherosclerosis in patients referred to planned non-cardiac interventions of intermediate and high risk. Material and methods. This retrospective analysis included 397 medical histories of patients who underwent planned interventions on aorta, carotid arteries, and peripheral arteries, PA (341 men and 56 women; mean age 60,0±13,0 years). Carotid endarterectomy (CEA) was performed in 161 patients (40,6%); PA intervention in 160 (40,3%); and abdominal aortic reconstruction in 76 (19,1%). Comparisons were performed by coronary angiography (CAG) results and immediate intervention results. Results. According to the CAG data, coronary artery (CA) stenosi

Gender-related features of reperfusion therapy in patients with ST segment elevation myocardial infarction

Aim. To investigate the gender differences in reperfusion therapy use among patients with ST segment elevation myocardial infarction (STEMI). Material and methods. The in-hospital therapy was assessed in 343 men and 186 women with STEMI. Results. There were significant differences in reperfusion rates among male and female patients. In total, reperfusion was performed in 265 men (77,2%) and 105 women (56,4%; р<0,05). Over 50% of the male patients underwent percutaneous coronary intervention (55,6%), in contrast with 39,2% of the female patients (р<0,05). The reason for this difference could be not gender per se, but co-existing diabetes mellitus, late diagnostics of acute coronary syndrome (ACS), and older age (over 70 years), which were more prevalent in women. Conclusion. Women with ACS are in need for more effective diagnostics and treatment