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

ABILITY OF THIOCTIC ACID IN THE TREATMENT OF PATIENTS WITH TYPE TWO DIABETES AFTER ACUTE MYOCARDIAL INFARCTION

Relevance: diabetic cardiovascular autonomic neuropathy (CAN) is considered as one diabetes-associated mechanism complicating the course and prognosis of myocardial infarction (MI). Objective:  to assess the effect of thioctic acid (TA) on the dynamics of indices of heart rate variability  (HRV) in patients with Type 2 diabetes mellitus 2 type (DM2) after acute IM.Materials and methods: we conducted an open randomized prospective study. It included 50 patients with T2DM after MI. For 10–14 days from the date of MI development a study of heart rate variability was done. Group 1 consisted of 10 patients with CAN, and they received TA (Thiogamma, Worwag Pharma GmbH & Co. KG (Germany) oral tablets at a dose of 600 mg per day for 3 months, 19 patients with CAN (Group 2) and 20 patients without CAN (Group 3) didn’t receive TA, 1 patient dropped out.Results: improvement of HRV after 3 months were in groups with low baseline area of the scatterogram clouds: in Group 1 the baseline value is 290 ms2 [202; 415] vs. 1025,5 ms2 [620; 1546] after 3 months (p = 0.005); in Group 2: 238 ms2 [162; 239] vs 531 ms2 [339; 795], p < 0.001. In Group 3 no significant changes were identified: 948,5 MS2 [783; 1642] vs 1220 MS2 [805; 1610] (p = 0,88). In patients with CAN, the largest increase of parameters of HRV was found in the group of TA intake: 706 ms2 [285; 1131]  in group 1 vs 284 ms2 [80; 506] in Group 2, p = 0,02.Conclusions: the use of TA at a dose of 600 mg for 3 months to treat a CAN in DM2 patients after acute MI is accompanied by a significant improvement of HRV indices

Prediktory vyzhivaemosti bol'nykh khronicheskoy serdechnoy nedostatochnost'yu, stradayushchikh sakharnym diabetom 2 tipa

Цель. Оценить выживаемость больных ХСН, страдающих СД 2; выявить параметры диабета, влияющие на течение и прогноз пациентов с недостаточностью кровообращения. Материалы и методы. Проведено исследование когорты дожития, которую составили 72 больных ХСН, страдающих СД 2. Судьба больных прослежена в течение 12 мес. У всех больных был собран анамнез и проведено физикальное обследование. Производилась оценка ФК ХСН. Выполнено Эхо-КГ. Исследовали уровень предсердного натрийуретического пептида (ПНУП). Результаты. Всего за 12 мес. наблюдения скончались 17 больных. Достоверно с выживаемостью связаны показатели тяжести ХСН, отражающие переносимость нагрузки (функциональный класс), клиническую характеристику (ШОКС) и нейрогуморальную активацию (ПНУП). Уровень ПНУП, более чем в 4 раза превышающий норму (т.е. более 8000 фмоль/мл), явился мощным предиктором неблагоприятного исхода в течение одного года. В группе выживших больные со ?стажем? СД более 10 лет составили 43% против 76% в группе скончавшихся. В группе больных с уровнем НвА1с менее 6,5% в половине случаев отмечались признаки хронической почечной недостаточности. При ХПН снижается активность почечной инсулиназы. достоверно на выживаемость оказывали влияние тяжесть ХСН и наличие уремической стадии диабетической нефропатии. На каждый балл увеличения ШОКС риск смерти в течение года возрастает на 25%. Наличие ХПН увеличивает риск смерти в 3 раза. Выводы. Почти 1/4 часть больных ХСН, страдающих СД 2, погибает в течение года. Существенное влияние на выживаемость оказывает исходная тяжесть ХСН. Наибольшее значение для прогноза среди характеристик СД 2 имеет диабетическая нефропатия. Ухудшение выживаемости отмечено уже на стадии микроальбуминурии. При наличии уремии риск смерти возрастает в 3 раза. Для быстрой оценки риска смерти в течение года можно ориентироваться на ШОКС и на наличие признаков ХПН. Для улучшения прогноза больных ХСН, страдающих СД 2, необходимо особое внимание уделять профилактике, ранней диагностике и лечению диабетического поражения почек

Effect of late culprit coronary artery revascularization on prognosis of patients with ST-elevation myocardial infarction

Aim. To evaluate the effect of culprit coronary artery revascularization after 48 hours from the symptoms’ onset on the prognosis of patients with ST-elevation myocardial infarction (STEMI).Material and methods. Of the 1172 patients admitted to City Clinical Hospital № 13 in 2018 due to STEMI, 43 patients (4%) were included in the retrospective study. There were following inclusion criteria: hospitalization after 48 hours from the symptoms’ onset, no clinical signs of myocardial ischemia, and complete coronary artery occlusion according to angiography. The mean age of the subjects was 61,3±10,6 years, 34 (79%) men and 9 (21%) women. The subjects were divided into two groups: group 1 (n=22) — management with percutaneous coronary intervention (PCI), group 2 (n=21) — management with medications. The groups differ only in the severity of coronary atherosclerosis according to SYNTAX score: group 1 — 14,0 [11.0; 19.5], group 2 — 26,0 [16,5; 31,0] (p=0,009). At the end of inpatient treatment, patients underwent echocardiography. Death and myocardial infarction were monitored during hospitalization and for 12 months after discharge.Results. During hospitalization, 2 patients died (4,7%; one in each group, p=1,00). No recurrent MI were reported. The left ventricular ejection fraction in the PCI group was 50 [46; 54] %, in the group with drug therapy — 43 [38; 50] % (p=0,01). Out of 43 included patients, long-term outcomes were followed up in 32 (74%). Among them, 1 (5,8%) patient died in group 1, 6 (33,3%) patients — in group 2 (p=0,04). In total, death or recurrent MI in the first group was observed in 2 (12%) patients, in the second group — in 5 (33%) patients (p=0,14).Conclusion. Revascularization of a fully occluded culprit coronary artery in stable patients with STEMI after 48 hours of symptoms’ onset is associated with a higher inhospital left ventricular ejection fraction and a decrease in 12-month mortality

Glycemia in patients with type 2 diabetes during inpatient treatment for acute myocardial infarction: impact on prognosis

Aim. To investigate the relationship between abnormal glycemia levels during inpatient treatment for acute myocardial infarction (AMI) in patients with type 2 diabetes (T2D) and long-term prognosis.Material and methods. The single-center cohort study included patients with AMI and concomitant T2D who were hospitalized consecutively for 200 days. A total of 237 patients were included. The median number of blood glucose measurements during hospitalization was 15 [8; 20] times. Long-term outcome was estimated at 365 days after hospitalization.Results. The first glycemic value on admission was 13,6±5,9, while the average glycemia during hospitalization was 10,0±3,5 mmol/L. Within 12 follow-up period, 53 deaths were recorded. It was found that exceeding the glycemic threshold of 10,0 mmol/L in more than 45% of measurements during hospitalization was associated with a 3-fold increase in the risk of an unfavorable outcome within 12 months. Predictors of poor glycemic control are insulin therapy before MI and blood glucose at admission >12,1 mmol/L.Conclusion. Poor glycemic control (>45% of glucose measurements above the threshold of 10,0 mmol/L) during hospitalization for AMI in patients with T2D is associated with an increased risk of in-hospital death and during the next 12 months, including in patients who underwent endovascular treatment

International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV) and the register “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2)

The organizer of the registers “Dynamics analysis of comorbidities in SARSCoV-2 survivors” (AKTIV) and “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2) is the Eurasian Association of Therapists (EAT). Currently, there are no clinical registries in the Eurasian region designed to collect and analyze information on long-term outcomes of COVID-19 survivors with comorbid conditions. The aim of the register is to assess the impact of a novel coronavirus infection on long-term course of chronic non-communicable diseases 3, 6, 12 months after recovery, as well as to obtain information on the effect of comorbidity on the severity of COVID-19. Analysis of hospitalized patients of a possible second wave is planned for register “AKTIV 2”. To achieve this goal, the register will include men and women over 18 years of age diagnosed with COVID-19 who are treated in a hospital or in outpatient basis. The register includes 25 centers in 5 federal districts of the Russian Federation, centers in the Republic of Armenia, the Republic of Kazakhstan, the Republic of Kyrgyzstan, the Republic of Belarus, the Republic of Moldova, and the Republic of Uzbekistan. The estimated capacity of the register is 5400 patients

International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV SARS-CoV-2): analysis of predictors of short-term adverse outcomes in COVID-19

The international AKTIV register presents a detailed description of out- and inpatients with COVID-19 in the Eurasian region. It was found that hospitalized patients had more comorbidities. In addition, these patients were older and there were more men than among outpatients. Among the traditional risk factors, obesity and hypertension had a significant negative effect on prognosis, which was more significant for patients 60 years of age and older. Among comorbidities, CVDs had the maximum negative effect on prognosis, and this effect was more significant for patients 60 years of age and older. Among other comorbidities, type 2 and 1 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cancer and anemia had a negative impact on the prognosis. This effect was also more significant (with the exception of type 1 diabetes) for patients 60 years and older. The death risk in patients with COVID-19 depended on the severity and type of multimorbidity. Clusters of diseases typical for deceased patients were identified and their impact on prognosis was determined. The most unfavorable was a cluster of 4 diseases, including hypertension, coronary artery disease, heart failure, and diabetes mellitus. The data obtained should be taken into account when planning measures for prevention (vaccination priority groups), treatment and rehabilitation of COVID-19 survivors

Clinical features of post-COVID period. Results of an International Register "Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (ACTIV SARS-CoV-2)" (12-month follow-up)

Aim. To investigate on post-COVID period in patients of the Eurasian region.Material and methods. A total of 9364 consecutively hospitalized patients were included in ACTIV registry. Enrollment of patients began on June 29, 2020, and was completed on March 30, 2021, corresponding to the first and second waves of the pandemic. Demographic, clinical, and laboratory data, computed tomography (CT) results, information about inhospital clinical course and complications of COVID-19 during hospitalization were extracted from electronic health records using a standardized data collection form. The design included follow-up telephone interviews with a standard questionnaire at 3, 6, and 12 months to examine the course of post-COVID period.Results. According to ACTIV register, 63% of patients after COVID-19 had new adverse symptoms or exacerbations of the existing symptoms lasting for up to 1 year. After hospital discharge, 79,8% of patients sought unscheduled medical attention in the first 3 months, 79,1% at 4-6 months, and 64,8% at 7-12 months. Readmission rate was 11,8% in the first 3 months, 10,9% at 4-6 months, and 10,1% at 7-12 months. The most common reasons for unscheduled treatment in the first 3 months were uncontrolled hypertension, decompensated type 2 diabetes, destabilization of coronary artery disease, gastrointestinal disease, AF episodes, exacerbation of asthma and chronic obstructive pulmonary disease, decompensated heart failure (HF). The 12-month mortality of COVID-19 survivors after the discharge was 3,08%. Multivariate analysis showed that independent risk factors for fatal outcome were age (direct correlation), the levels of hemoglobin (inverse correlation), oxygen saturation (inverse correlation), and aspartate aminotransferase (direct correlation), as well as class III-IV HF, prior stroke, cancer, inhospital acute kidney injury. Based on these identified risk factors, a nomogram was constructed to determine the 3-month mortality risk after discharge.Conclusion. Analysis of ACTIV register showed that end of the acute phase of COVID-19 does not imply a complete recovery

Lipid profile in hospitalized patients with COVID-19 depending on the outcome of its acute phase: data from the international registry "Dynamics analysis of comorbidities in SARS-CoV-2 infection survivors"

Aim. To study the lipid profile in hospitalized patients with coronavirus disease 2019 (COVID-19) depending on the outcome of its acute phase according to the AKTIV international registry.Material and methods. The AKTIV registry included men and women over 18 years of age with a diagnosis of COVID-19, who were treated in a hospital. A total of 9364 patients were included in the registry, of which 623 patients were analyzed for levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides on days 1-2 of hospitalization. The level of high-density lipoprotein cholesterol (HDL-C) was calculated using the Friedewald equation.Results. We found that a decrease in LDL-C level was significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. This pattern persisted in both univariate and multivariate analyses. LDL-C levels in the final multivariate model had a significant relationship with the prognosis (an increase in the death risk by 1,7 times with a decrease per 1 mmol/l). In addition, we found that the survival of patients with an indicator level of <2,45 mmol/l is significantly worse than in patients with an LDL-C level ≥2,45 mmol/l. All patients with high LDL-C ((≥4,9 mmol/l) survived, while among patients with low LDL-C (<2,45 mmol/l. All patients with high LDL-C ((≥4,9 mmol/l) survived, while among patients with low LDL-C (<1,4 mmol/l), mortality was 13,04%, which was significantly higher than in patients with LDL-C ≥1,4 mmol/l (6,32%, p=0,047).Conclusion. A decrease in LDL-C in the acute period is significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. Determination of LDL-C can be included in the examination program for patients with COVID-19. However, the predictive value of this parameter requires further study in prospective clinical studies