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

TREATMENT CHARACTERISTICS OF ACUTE CORONARY SYNDROME IN ELDERLY PATIENTS: PRACTICE OF N.I. PIROGOV CITY CLINICAL HOSPITAL №1

Aim. Assessment of compliance the management of elderly patients (≥75 years) with acute coronary syndrome (ACS) with existing guidelines and evaluation of ACS features during the last two years of working period of the Regional vascular center and compare the results with the data from Russian and foreign registries, randomized clinical studies (RCS) and recommendations. Material and methods. Analysis of diagnostic and treatment data of 999 patients, aged 75 years and over, who were taken by ambulance or made their own way to N. I. Pirogov City Clinical Hospital №1 (CCH №1) in Moscow and were hospitalized during the period between the 1st January 2014 and the 31st of December 2015 in the intensive care unit for patients with myocardial infarction with the initial diagnoses of ACS, myocardial infarction and unstable angina. Results. The elderly patients with ACS admitted to the CCH №1 in 2014 and 2015 were 41% and 54% of all patients with ACS, respectively; women prevailed in all age subgroups. There was no age difference between the subgroups of ACS in patients with elevation ST-segment and ACS in patients without ST-segment elevation. A high frequency of comorbidity in the elderly patients with ACS was observed; hypertension was the most common disease with an incidence rate of 95% without significant difference between the genders. The incidence of percutaneous coronary intervention (PCI) and coronary angiography (CAG) significantly increased in 2015 compared with 2014 (p<0.0001, risk ratio 0.56, 95% confidence interval 0.420.76). A reduction in hospital deaths was also found (p<0.0001, risk ratio 1.51, 95% confidence interval 0.94-2.43). Dual antiplatelet therapy (DAT) was prescribed to elderly patients in clinical practice approximately in 70% of cases; DAT was performed significantly more often in 2015 than in 2014. Conclusion. There are a high percentage of the elderly patients with ACS admitted to the CCH №1. This proportion is dramatically higher than this in the Russian and foreign registries and RCS, that could influence on the outcome of patient care. The widespread use of interventional diagnostic and treatment methods (CAG and PCI) allows to improve substantially the clinical outcomes of ACS. A possibility of unconditional following the guidelines regarding the prescription of DAT to the elderly patients with ACS in real clinical practice may be limited by the high incidence of concomitant pathology

How Does the Presence of Diabetes Affect the Course of Acute Coronary Syndrome in Elderly Patients in Actual Clinical Practice?

The number of elderly patients with diabetes mellitus (DM) is constantly growing in general population. Accordantly, we have the growth of such patients in the group of acute coronary syndrome (ACS).Aim. To compare clinical characteristics of the elderly patient (>75 years old) with and without DM.Material and methods. This retrospective study included 1133 ACS patients who were aged ≥75 years and admitted to the City Clinical Hospital №1 from 01.01.2015 to 31.12.2016. Median age was 80 years, 66% were women. We analyzed 4 patient subgroups: Group 1 – 105 patients with ST-segment elevation myocardial infarction (STEMI) and DM, Group 2 – 254 STEMI patients without DM, Group 3 – 222 non-STEMI patients with DM and Group 4 – 552 non-STEMI patients without DM. We used Student’s t-test and c2 tests to find significant difference between pairs of groups.Results. Median age of patients in 4 groups was 80, 81, 81 and 80 years (p>0.05), age variance was 75-100 years. DM was found in 29% of all elderly patients with no difference between STEMI and non-STEMI groups. STEMI and non-STEMI patients with DM were more likely women. NonSTEMI patients with DM more often had hypertension, previous stroke, lower median Hb (121 vs 127 g/l; p<0.001). Angiography data demonstrated more often three-vessel disease (43% vs 29.7%) and less one-vessel disease (15% vs 25.6%; p<0.05) between groups 3 and 4. Glomerular filtration rate (GFR) <60 ml/min/1.73 m2 occurred in 74%, 73%, 77% and 74% in patients of 4 groups (p>0,05), but GFR<45 ml/min/1.73 m2 was more prevalent in patients with DM than without DM: 45%, 39%, 45%, 36% in 4 groups. Finally, mortality rates didn’t demonstrate significant difference between DM and non-DM patients with STEMI (10% vs 13%; p>0.05) and non-STEMI (7% vs 7%) groups.Conclusion. DM is associated with ACS approximately in one third of the elderly patients and is not associated with its type (STEMI or non-STEMI). In STEMI and non-STEMI patients the female sex and GFR level <45 ml/min/1.73 m2 were associated with DM. In non-STEMI group multi-vessel disease and presence of hypertension and previous stroke were associated with DM. We didn’t find any difference between mortality in elderly patients with and without DM