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Π Π΅Π°Π»ΠΈΠ·Π°ΡΠΈΡ Β«Π±Π΅ΡΡΠΎΠ²Π½ΠΎΠΉΒ» ΠΌΠΎΠ΄Π΅Π»ΠΈ ΠΎΠΊΠ°Π·Π°Π½ΠΈΡ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Ρ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡΡ
Heart failure (HF) is a widespread disease and tends to increase. Despite the possibilities of modern therapy, the prognosis of patients with HF remains unfavorable. Foreign experience shows that the creation of specialized heart failure clinics improves the quality of care for patients with HF, reduces the frequency of repeated hospitalizations and death of patients. The Russian Federation has gained experience in creating such clinics, in particular, in Nizhny Novgorod, Ufa, St. Petersburg and a number of other cities. The article describes the organization of the work of the Center for HF on the basis of a multidisciplinary hospital in Moscow in period 01.11.2020-01.12.2022. The database included 2,400 patients hospitalized due to acute decompensation of chronic HF (ADCHF). The leading triggers of ADCHF in the studied patient population were an episode of atrial fibrillation/flutter (37 %), low adherence to treatment (25 %) and uncontrolled hypertension (17 %), exacerbation of concomitant diseases (11 %), infection (4 %). In 6 % of patients, the leading trigger could not be identified. The hospital stage included 950 (39.5 %) patients who, in the first 24 hours from the moment of hospitalization, underwent standard physical, laboratory and instrumental examination, including lung ultrasound, NT-proBNP, liver fibroelastometry, VEXUS protocol study, bioimpedance analysis of body composition, of which 496 (20.5 %) people passed the same studies at discharge. In the structure of patients hospitalized with ADCHF who were included in the hospital follow-up stage (n=950), patients with preserved (HFpEF) 42.5 % (n=404) and reduced ejection fraction (HFrEF) prevailed 36 % (n=342), patients with a mildly reduced (HFmrEF) ejection fraction were found in 21.5 %. 1,552 (64.5 %) patients refused additional studies and visits to the CH center, but agreed to outpatient follow-up in the form of telephone contacts. In 370 (15.4 %) patients, contact was lost after discharge. 240 (10 %) patients actively visit the HF center with a comprehensive assessment of congestion and correction of therapy at each visit. Conclusion. There are two stages in the treatment of patients with chronic HF. The first stage is hospital, the second one is outpatient. It is important not to make omissions in the prescribed drug therapy, which can lead to a fatal outcome. To this end, it is necessary to introduce a βseamlessβ model of medical care for patients with chronic HF, when the patient comes under the supervision of a multidisciplinary team that carries out timely monitoring.Π‘Π΅ΡΠ΄Π΅ΡΠ½Π°Ρ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡ (Π‘Π) ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠΈΡΠΎΠΊΠΎ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΡΠΌ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅ΠΌ ΠΈ ΠΈΠΌΠ΅Π΅Ρ ΡΠ΅Π½Π΄Π΅Π½ΡΠΈΡ ΠΊ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΡ. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΏΡΠΎΠ³Π½ΠΎΠ· ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π‘Π ΠΎΡΡΠ°Π΅ΡΡΡ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠΌ. ΠΠ°ΡΡΠ±Π΅ΠΆΠ½ΡΠΉ ΠΎΠΏΡΡ ΠΏΠΎΠΊΠ°Π·ΡΠ²Π°Π΅Ρ, ΡΡΠΎ ΡΠΎΠ·Π΄Π°Π½ΠΈΠ΅ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΊΠ»ΠΈΠ½ΠΈΠΊ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ ΡΠ»ΡΡΡΠ°Π΅Ρ ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎ ΠΎΠΊΠ°Π·Π°Π½ΠΈΡ ΠΏΠΎΠΌΠΎΡΠΈ Π±ΠΎΠ»ΡΠ½ΡΠΌ Ρ Π‘Π, ΡΠ½ΠΈΠΆΠ°Π΅Ρ ΡΠ°ΡΡΠΎΡΡ ΠΏΠΎΠ²ΡΠΎΡΠ½ΡΡ
Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΉ ΠΈ ΡΠΌΠ΅ΡΡΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ
. Π Π ΠΎΡΡΠΈΠΉΡΠΊΠΎΠΉ Π€Π΅Π΄Π΅ΡΠ°ΡΠΈΠΈ ΠΏΠΎΡΠ²ΠΈΠ»ΡΡ ΠΎΠΏΡΡ ΡΠΎΠ·Π΄Π°Π½ΠΈΡ ΡΠ°ΠΊΠΈΡ
ΠΊΠ»ΠΈΠ½ΠΈΠΊ, Π² ΡΠ°ΡΡΠ½ΠΎΡΡΠΈ Π² ΠΠΈΠΆΠ½Π΅ΠΌ ΠΠΎΠ²Π³ΠΎΡΠΎΠ΄Π΅, Π£ΡΠ΅, Π‘Π°Π½ΠΊΡ-ΠΠ΅ΡΠ΅ΡΠ±ΡΡΠ³Π΅ ΠΈ ΡΡΠ΄Π΅ Π΄ΡΡΠ³ΠΈΡ
Π³ΠΎΡΠΎΠ΄ΠΎΠ². Π ΡΡΠ°ΡΡΠ΅ ΠΎΠΏΠΈΡΠ°Π½Π° ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΡ ΡΠ°Π±ΠΎΡΡ Π¦Π΅Π½ΡΡΠ° ΠΏΠΎ Π‘Π Π½Π° Π±Π°Π·Π΅ ΠΌΠ½ΠΎΠ³ΠΎΠΏΡΠΎΡΠΈΠ»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ° Π² Π³. ΠΠΎΡΠΊΠ²Π° Ρ 01.11.2020 ΠΏΠΎ 01.12.2022 Π³Π³. Π Π±Π°Π·Ρ Π΄Π°Π½Π½ΡΡ
Π±ΡΠ»ΠΎ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΎ 2400 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Π² ΡΠ²ΡΠ·ΠΈ Ρ ΠΎΡΡΡΠΎΠΉ Π΄Π΅ΠΊΠΎΠΌΠΏΠ΅Π½ΡΠ°ΡΠΈΠ΅ΠΉ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π‘Π (ΠΠΠ₯Π‘Π). ΠΠΎΠΊΠ°Π·Π°Π½ΠΎ, ΡΡΠΎ Π²Π΅Π΄ΡΡΠΈΠΌΠΈ ΡΡΠΈΠ³Π³Π΅ΡΠ°ΠΌΠΈ ΠΠΠ₯Π‘Π Π² ΠΈΡΡΠ»Π΅Π΄ΡΠ΅ΠΌΠΎΠΉ ΠΏΠΎΠΏΡΠ»ΡΡΠΈΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠ²Π»ΡΠ»ΠΈΡΡ ΡΠΏΠΈΠ·ΠΎΠ΄ ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠΈ/ΡΡΠ΅ΠΏΠ΅ΡΠ°Π½ΠΈΡ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ (37 %), Π½ΠΈΠ·ΠΊΠ°Ρ ΠΏΡΠΈΠ²Π΅ΡΠΆΠ΅Π½Π½ΠΎΡΡΡ ΠΊ Π»Π΅ΡΠ΅Π½ΠΈΡ (25 %) ΠΈ Π½Π΅ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈΡΡΠ΅ΠΌΠ°Ρ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½Π°Ρ Π³ΠΈΠΏΠ΅ΡΡΠΎΠ½ΠΈΡ (17 %), ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ ΡΠΎΠΏΡΡΡΡΠ²ΡΡΡΠΈΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ (11 %), ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ (4 %). Π£ 6 % ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π²Π΅Π΄ΡΡΠΈΠΉ ΡΡΠΈΠ³Π³Π΅Ρ Π²ΡΠ΄Π΅Π»ΠΈΡΡ Π½Π΅ ΡΠ΄Π°Π»ΠΎΡΡ. Π Π³ΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½ΡΠΉ ΡΡΠ°ΠΏ Π±ΡΠ»ΠΈ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ 950 (39,5 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΊΠΎΡΠΎΡΡΠΌ Π² ΠΏΠ΅ΡΠ²ΡΠ΅ 24 ΡΠ°ΡΠ° ΠΎΡ ΠΌΠΎΠΌΠ΅Π½ΡΠ° Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ, ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΠΎΠ΅ ΡΠΈΠ·ΠΈΡΠ΅ΡΠΊΠΎΠ΅, Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΠΎΠ΅ ΠΈ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΠΎΠ΅ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅, Π²ΠΊΠ»ΡΡΠ°Ρ Π£ΠΠ Π»Π΅Π³ΠΊΠΈΡ
, NT - proBNP, ΡΠΈΠ±ΡΠΎΡΠ»Π°ΡΡΠΎΠΌΠ΅ΡΡΠΈΡ ΠΏΠ΅ΡΠ΅Π½ΠΈ, ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΠΎ ΠΏΡΠΎΡΠΎΠΊΠΎΠ»Ρ VEXUS, Π±ΠΈΠΎΠΈΠΌΠΏΠ΅Π΄Π°Π½ΡΠ½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ΡΠΎΡΡΠ°Π²Π° ΡΠ΅Π»Π°. ΠΠ· 950 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² 496 (20,5 %) ΡΠ΅Π»ΠΎΠ²Π΅ΠΊ ΠΏΡΠΎΡΠ»ΠΈ ΡΠ΅ ΠΆΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΏΡΠΈ Π²ΡΠΏΠΈΡΠΊΠ΅. Π ΡΡΡΡΠΊΡΡΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Ρ ΠΠΠ₯Π‘Π, ΠΊΠΎΡΠΎΡΡΠ΅ Π±ΡΠ»ΠΈ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ Π² Π³ΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½ΡΠΉ ΡΡΠ°ΠΏ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ (n = 950), ΠΏΡΠ΅ΠΎΠ±Π»Π°Π΄Π°Π»ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Ρ ΡΠΎΡ
ΡΠ°Π½Π½ΠΎΠΉ 42,5 % (n = 404) ΠΈ Π½ΠΈΠ·ΠΊΠΎΠΉ ΡΡΠ°ΠΊΡΠΈΠ΅ΠΉ Π²ΡΠ±ΡΠΎΡΠ° 36 % (n=342), ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Ρ ΡΠΌΠ΅ΡΠ΅Π½Π½ΠΎ Π½ΠΈΠ·ΠΊΠΎΠΉ ΡΡΠ°ΠΊΡΠΈΠ΅ΠΉ Π²ΡΠ±ΡΠΎΡΠ° Π²ΡΡΡΠ΅ΡΠ°Π»ΠΈΡΡ Π² 21,5 %. 1552 (64,5 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΠΎΡΠΊΠ°Π·Π°Π»ΠΈΡΡ ΠΎΡ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΠΈ Π²ΠΈΠ·ΠΈΡΠΎΠ² Π² ΡΠ΅Π½ΡΡ Π‘Π ΠΏΠΎΡΠ»Π΅ Π²ΡΠΏΠΈΡΠΊΠΈ, ΠΎΠ΄Π½Π°ΠΊΠΎ Π΄Π°Π»ΠΈ ΡΠΎΠ³Π»Π°ΡΠΈΠ΅ Π½Π° Π°ΠΌΠ±ΡΠ»Π°ΡΠΎΡΠ½ΠΎΠ΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ Π² Π²ΠΈΠ΄Π΅ ΡΠ΅Π»Π΅ΡΠΎΠ½Π½ΡΡ
ΠΊΠΎΠ½ΡΠ°ΠΊΡΠΎΠ². Π£ 370 (15,4 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΠΎΡΠ»Π΅ Π²ΡΠΏΠΈΡΠΊΠΈ ΠΊΠΎΠ½ΡΠ°ΠΊΡ Π±ΡΠ» ΡΡΠ΅ΡΡΠ½. 240 (10 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π°ΠΊΡΠΈΠ²Π½ΠΎ ΠΏΠΎΡΠ΅ΡΠ°ΡΡ ΡΠ΅Π½ΡΡ Π‘Π Ρ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ΠΌ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΠΎΠΉ ΠΎΡΠ΅Π½ΠΊΠΈ Π·Π°ΡΡΠΎΡ ΠΈ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠΈ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π½Π° ΠΊΠ°ΠΆΠ΄ΠΎΠΌ Π²ΠΈΠ·ΠΈΡΠ΅. ΠΡΠ²ΠΎΠ΄Ρ. ΠΡΠΈ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π‘Π Π²ΡΠ΄Π΅Π»ΡΡΡ Π΄Π²Π° ΡΡΠ°ΠΏΠ°. ΠΠ΅ΡΠ²ΡΠΉ ΡΡΠ°ΠΏ - Π³ΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½ΡΠΉ, Π²ΡΠΎΡΠΎΠΉ - Π°ΠΌΠ±ΡΠ»Π°ΡΠΎΡΠ½ΡΠΉ. ΠΠ°ΠΆΠ½ΠΎ Π½Π΅ Π΄ΠΎΠΏΡΡΠΊΠ°ΡΡ ΠΏΡΠΎΠΏΡΡΠΊΠΎΠ² Π² Π½Π°Π·Π½Π°ΡΠ΅Π½Π½ΠΎΠΉ ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½ΡΠΎΠ·Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, ΡΡΠΎ ΠΌΠΎΠΆΠ΅Ρ ΠΏΡΠΈΠ²Π΅ΡΡΠΈ ΠΊ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΠΌΡ ΠΈΡΡ
ΠΎΠ΄Ρ. Π‘ ΡΡΠΎΠΉ ΡΠ΅Π»ΡΡ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎ Π²Π½Π΅Π΄ΡΠΈΡΡ Β«Π±Π΅ΡΡΠΎΠ²Π½ΡΡΒ» ΠΌΠΎΠ΄Π΅Π»Ρ ΠΎΠΊΠ°Π·Π°Π½ΠΈΡ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ Π±ΠΎΠ»ΡΠ½ΡΠΌ Ρ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π‘Π, ΠΊΠΎΠ³Π΄Π° ΠΏΠ°ΡΠΈΠ΅Π½Ρ ΠΏΠΎΡΡΡΠΏΠ°Π΅Ρ ΠΏΠΎΠ΄ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ ΠΌΠ½ΠΎΠ³ΠΎΠΏΡΠΎΡΠΈΠ»ΡΠ½ΠΎΠΉ Π±ΡΠΈΠ³Π°Π΄Ρ, ΠΎΡΡΡΠ΅ΡΡΠ²Π»ΡΡΡΠ΅ΠΉ ΡΠ²ΠΎΠ΅Π²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠ΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅