ORGANIZATIONAL ISSUES OF CARDIOREHABILITATION SERVICE IN RUSSIA. THE RESULTS OF PILOT PROJECT “DEVELOPMENT OF REHABILITATION SYSTEM OF CARDIOVASCULAR PATIENTS IN MEDICAL INSTITUTIONS OF RUSSIAN FEDERATION ENTITIES”

Aim. To analyze,  how is, under  the  framework of the  Pilot Project, organized and being conducted  the improvement of work of the known departments in exact medical institutions (MI) of RF for rehabilitation of cardiovascular  diseases (CVD) patients  at the  three  steps  under  the current “Order of medical care and medical rehabilitation”, and how do the scientifically proven and types and methods  of cardiorehabilitation (CR) being implemented,  and to try to elaborate  on an exact algorithm for patients course.Material and methods. Into the Pilot Project, 17 MI included, from 13 entities of RF. For the analysis of effectiveness of organizational models of CR in MI the unified charts were developed making to assess the equality to the  Order  of the  rehabilitation care  provided to patients  with CVD, of multidisciplinary team  involved in care,  the staff list and MI equipment. Specific charts included the units assessing the efficacy of work on three stages of CR: I stage — in resuscitation and intensive care unit or specialized cardiology department, II — in in-patient department, III — in polyclinics. The article presents data from CR analysis of Jan 2013 to Dec 2015. Results. The CR was organized at the stage I in 10 MI, stage II in 10 MI and stage III in 7 MI. By the year 2015, almost in all MI the multidisciplinary teams   were  shaped,   including  cardiologist,  cardiorehabilitologist, exercise specialist, clinical psychologist, physiotherapist; the rooms for exercise were equipped, as the halls for education of patients. The start of rehabilitation process  from ICU made it to decrease the remaining of patient on the bedside for 0,7 days in average (2013-2015) and for 1 day in cardiovascular department. About 67% myocardial infarction patients in average  were transferred  to the stage  II of CR. In all MI there  were educational  Schools  organized,  and  the  explanatory  talks  with the relatives were done as well. By now, the project is on its way. Conclusion. The analysis of three-staged CR system  for myocardial infarction  patients   according   to  current   laws,  showed  significant improvement  of  rehabilitational  activeness   of  the  newly  created multidisciplinary teams  at all stages  of CR, increase  of the number of methods  of CR and  better  fulfillment of those,  as  demonstrated the safety of proposed  principals of physical rehabilitation according to the Russian  clinical guidelines  “Myocardial infarction with ST elevation: rehabilitation and  secondary  prevention” under  the framework of the organizational model of CR