Reducing geographic inequalities in access times for acute treatment of myocardial infarction in a large country: the example of Russia.

Background: Russia has the largest area of any country in the world and has one of the highest cardiovascular mortality rates. Over the past decade, the number of facilities able to perform percutaneous coronary interventions (PCIs) has increased substantially. We quantify the extent to which the constraints of geography make equitable access to this effective technology difficult to achieve. Methods: Hospitals performing PCIs in 2010 and 2015 were identified and combined with data on the population of districts throughout the country. A network analysis tool was used to calculate road-travel times to the nearest PCI facility for those aged 40+ years. Results: The number of PCI facilities increased from 144 to 260 between 2010 and 2015. Overall, the median travel time to the closest PCI facility was 48 minutes in 2015, down from 73 minutes in 2010. Two-thirds of the urban population were within 60 minutes' travel time to a PCI facility in 2015, but only one-fifth of the rural population. Creating 67 new PCI facilities in currently underserved urban districts would increase the population share within 60 minutes' travel to 62% of the population, benefiting an additional 5.7 million people currently lacking adequate access. Conclusions: There have been considerable but uneven improvements in timely access to PCI facilities in Russia between 2010 and 2015. Russia has not achieved the level of access seen in other large countries with dispersed populations, such as Australian and Canada. However, creating a relatively small number of further PCI facilities could improve access substantially, thereby reducing inequality

The management of acute myocardial infarction in the Russian Federation: protocol for a study of patient pathways

Death rates from cardiovascular disease in Russia are among the highest in the world. In recent years, the Russian government has invested substantially in the healthcare system, with a particular focus on improving access to advanced technology, especially for acute myocardial infarction (AMI). This protocol describes a study to understand the management of AMI in different Russian regions, investigating the role of patient, clinical, and health system characteristic

How has the management of acute coronary syndrome changed in the Russian Federation during the last 10 years?

METHODS: We report trends and patterns of percutaneous cardiovascular interventions (PCI) by region for 2005-2009, with more detailed data on management of myocardial infarctions in 2009-2103, relating them to regional economic development and changes in mortality from myocardial infarction. RESULTS: PCIs per 100,000 population increased from 8.7 in 2005-71.3 in 2013, with considerable regional variation. In 2013 the highest rates were in the wealthiest regions, although not in some remote regions dependent on oil and mineral extraction. Between 2009 and 2013 rates of thrombolysis in those with acute myocardial infarctions potentially eligible for treatment remained broadly similar at about 28% but rates of primary revascularisation with stenting rose rapidly, from 6.5% to 23.7%. In-hospital mortality from myocardial infarction since 2009 has declined most in regions achieving highest rates of primary revascularisation. CONCLUSIONS: The sustained investment in advanced cardiovascular technology has been associated with substantial increases in revascularisation in some but not all regions. However, rates overall remain far behind those in Western Europe. Further research is in progress to understand the reasons for these variations and the barriers to further expansion of services

COSTS OF THE HEALTH CARE IN RUSSIA ASSOCIATED WITH SMOKING

Aim. To analyze costs of health care in Russia associated with smoking in 2009. Material and methods. Cardiovascular diseases, cancers and chronic obstructive pulmonary diseases (COPD) were included in the analysis. Calculation was performed on the basis of the relative risks of diseases associated with smoking, and obtained from foreign surveys, official statistics on morbidity and health system resources expenditure, and costs of health-seeking in line with state program of guaranteed free medical care.  Results. In 2009 total costs of the health care system associated with smoking exceeded RUR 35.8 bln. It corresponded to 0.1% of gross domestic product in Russia in 2009. The costs structure was the following: hospitalization – RUR 26.2 bln, emergency calls – RUR 1.4 bln, and outpatient health-seeking – RUR 8.2 bln. Costs of outpatient pharmacotherapy were not included into analysis because of lack of baseline data needed for calculations. Cardiovascular diseases caused 62% of the health care costs associated with smoking, cancers – 20.2%, and COPD – 17.8%. Conclusion. The smoking in Russia is associated with significant health care costs. It makes needed resources investment in preventive programs to reduce smoking prevalence

Management of patients with acute ST-segment elevation myocardial infarction in Russian hospitals adheres to international guidelines

Objective - Russia has one of the highest cardiovascular mortality rates. Modernisation of the Russian health system has been accompanied by a substantial increase in uptake of percutaneous coronary intervention (PCI), which substantially reduces the risk of mortality in patients with acute ST-elevation myocardial infarction (STEMI). This paper aims to describe contemporary Hospital treatment of acute STEMI among patients in a range of hospitals in the Russian Federation. Methods - This study used data from a prospective observational cohort of 1128 suspected patients with myocardial infarction recruited in both PCI and non-PCI hospitals across 13 regions and multiple levels of the health system in Russia. The primary objective was to examine the use of reperfusion strategies in patients with STEMI. Results - Among patients reaching PCI centres within 12 hours of symptom onset, the vast majority received angiography and PCI, regardless of age, sex and comorbidity, in line with current European Society of Cardiology guidelines. Conclusion- Patients reaching Russian hospitals are very likely to receive appropriate treatment, although performance varies. The best hospitals can serve as beacons of good practice as PCI facilities continue to expand across Russia where geography allows

Effects of female sexual chemosignals on mucosal immunity in BALB/c and C57BL/6 male mice

The immune response to immunogenic stimuli depends on various factors like cytokine context, way of entry, and immune status of the organism. In mice, female chemosignal entry into the male organism via the respiratory system causes activation of the mucosal immune response, which leads to the development of enhanced resistance to infections and is of adaptive value. However, the activation of mucosal immunity depends on the genetic predispositions of the immune response. BALB/c and C57BL/6 are prototypically Th2- and Th1-type mouse strains, respectively, therefore, they can serve as perfect model organisms for studying mechanism of lung mucosal immune activation in response to female chemosignals. Respiratory tract mucosal immune response to intranasal application of LPS, urea solution, saline and female urine used as a chemosignal was investigated in BALB/c and C57BL/6 male mice. Application of both female urine and LPS increased total white blood cell count and protein concentration in bronchoalveolar lavage fluid in BALB/c, but not in C57BL/6 male mice, suggesting an important role of Th2 pathway in lung mucosal immune response. At the same time, urine application provoked a significantly lower plasma corticosterone elevation than LPS. Thus, sexual signals associated with infection risks provide genotype-dependent mobilization of innate immunity without significant activation of physiological stress mechanisms

SOCIO-ECONOMIC DAMAGE BY ACUTE CORONARY SYNDROME IN RUSSIAN FEDERATION

Aim. To estimate the economic damage by acute coronary syndrome (ACS) in Russia in 2006-2009. Material and Methods. Direct costs and economic losses associated with ACS were estimated. The structure of direct costs includes the costs of hospitalization, medical emergencies, out-patient visits, high-tech medical care, as well as drug therapy in outpatient treatment. Losses in the economy associated with ACS include loss of gross domestic product due to death in working-age, temporary disability and payments of disability benefits. Estimation of economic damage by cardio-vascular diseases was based on analysis of Russian Ministry of Health official statistics. Results. Approximately 520,000 cases of ACS are registered annually (36,4% - myocardial infarction, 63,6% - unstable angina). Trend to increased mortality from myocardial infarction, especially among women, was found during the analyzed period. From 2000 to 2009 this index rose from 34.9 to 41.1 per 100,000 of population among women, and from 52.3 to 55.9 per 100,000 of population among men. Total direct costs of health care for patients with ACS in 2009 amounted to almost 21 billion rubles, and indirect – 53.5 billion rubles. The total economic damage by ACS in Russia in 2008-2009 exceeded 70 billion rubles per year. Conclusion. ACS in Russia is connected with significant social and economic damage. Most part of this damage is indirect losses in economy due to premature mortality of working aged men

Level and correlations of soluble suppression of tumorigenicity 2 protein in heart failure and its relationship with clinical and paraclinical characteristics of patients

Aim. To establish the correlations of the soluble suppression of tumorigenicity 2 protein (sST2) and N-terminal pro-brain natriuretic peptide (NT-proBNP) with some clinical and paraclinical characteristics of patients with heart failure (HF).Material and methods. The study included 130 patients with HF (men — 54, women — 76, mean age, 64,3±8,3 years) from the regional registry of HF patients in the Voronezh Oblast. All patients underwent echocardiography and general clinical investigations. In addition, the serum levels of sST2 and NT-proBNP were determined and their correlations with other parameters were studied.Results. The blood level of sST2 in HF patients was 339,8 [266;405] pg/ml. In the study sample of patients with HF, sST2 levels correlated with right atrial (r=0,49) and right ventricular (r=0,32) sizes, left ventricular end-diastolic dimension (r=0,34) and volume (r=0,33), left ventricular early diastolic filling rate (r=-0,35), blood calcium level (r=-0,55) and functional class of exertional angina (r=-0,37).Conclusion. The data obtained may indicate a pathogenetic relationship between sST2 and systolic and diastolic dysfunction of the left ventricle and right heart

Drugs influencing on PCSK9 activity: modelling of efficacy in patients who had myocardial infarction with uncontrolled dyslipidemia

Cardiovascular diseases are the leading cause of death worldwide. It is possible to influence the development of these diseases by influencing their main pathogenetic link — dyslipidemia.Aim: to evaluate, using the example of alirocumab, the potential effect of drugs affecting the activity of PCSK9 on the achievement of goals for the prevention of the development of cardiovascular diseases and cardiovascular complications in patients of working age who had an acute myocardial infarction (MI) less than a year ago, with uncontrolled dyslipidemia.Materials and methods. The target group was created based on the Russian clinical guidelines; its number was calculated using Russian registry data. Based on the published results of the clinical trial of alirocumab ODYSSEY OUTCOMES in a group of patients with LDL cholesterol levels of more than 2.6 mmol/l (100 mg/dl), a model was built to estimate the number of fatal and non-fatal outcomes in the target group with standard therapy and with alirocumab.Results. The effect of alirocumab administration was modeled in patients of working age who had a myocardial infarction less than 12 months ago with an LDL cholesterol level of more than 5.0 mmol/l, the number of this group in the Russian Federation was estimated to be 3,029 people. It has been shown that with therapy in this group, mortality can be reduced by 29%, and the number of non-fatal cardiovascular events — by 22%, i. e. alirocumab therapy in this group for 2 years can prevent 29 deaths and 185 non-fatal events, with an increase in the duration of therapy to 5 years, the number of lives saved will be 117 and 401 non-fatal cardiovascular events will be prevented.Conclusion. Modeling has shown that alirocumab therapy in patients with recent myocardial infarction and LDL cholesterol levels above 5.0 mmol/L will significantly reduce mortality in this group and prevent the development of serious nonfatal cardiovascular complications, which will also reduce the burden on specialized hospitals, as well as prevent patients from becoming disabled. At the same time, decision making requires a balanced consideration of all ethical, clinical and economic aspects, including the assessment of costs and potential effects from the position of the of a willingness to pay and the formation of the budget of the health system

Hospital stage of myocardial infarction treatment in 13 Regions of Russian Federation by results of the international research

Aim: To describe the characteristics of the patient with MI who is admitted to a hospital and to characterize the main diagnostic and treatment interventions in clini