Epidemiology of atrial fibrillation in a representative sample of the European part of the Russian Federation. Analysis of EPOCH-CHF study.

Aim    To study true prevalence of atrial fibrillation (AF) in a representative sample from the European part of the Russian Federation; to describe characteristics of patients with AF; and to provide the frequency of anticoagulant treatment.Material and methods    Cross-sectional data of the EPOCH epidemiological study (2017) were used. Data were collected in 8 constituent entities of the Russian Federation; the sample size was 11 453 people. The sample included all respondents who had given their consent for participation and were older than 10 years. Statistical tests were performed in the R system for statistical data analysis.Results    The prevalence of AF in the representative sample from the European part of the Russian Federation was 2.04 %. The AF prevalence increased with age and reached a maximum value of 9.6% in the age group of 80 to 89 years. The AF prevalence among females was 1.5 times higher than among men. With age standardization, the AF prevalence was 18.95 and 21.33 per 1,000 people for men and women, respectively. The AF prevalence increased in the presence of concurrent cardiovascular diseases (CVDs) or diabetes mellitus as well as with an increased number of comorbidities in the same person and reached 70.3 and 60.0 % in patients with 4 and 5 comorbidities, respectively. Patients with AF had a greater number of comorbidities and higher CHA2DS2VASc scores (5.0 vs. 2.0, p<0.001) compared to patients with CVDs without AF. Only 22.6 % of patients with CVD and AF took anticoagulants. Only 23.9% of patients with absolute indications for the anticoagulant treatment received anticoagulants.Conclusion    The AF prevalence in the European part of the Russian Federation was 2.04 %; it increased with age and in patients with concurrent CVDs or diabetes mellitus. Most of AF patients (93.2 %) required a mandatory treatment with oral anticoagulants.

Experience of introducing a new form of organization of medical care for patients with heart failure in the Russian Federation.

Aim    To present clinical characteristics of patients after hospitalization for acute decompensated heart failure (ADHF) and to analyze hemodynamic indexes and compliance with the treatment at two years depending on the conditions of outpatient follow-up.Material and methods    The study included 942 patients with chronic heart failure (CHF) older than 18 years who had been hospitalized for ADHF. Based on patients' decisions, two groups were isolated: patients who continued the outpatient follow-up at the Center of CHF (CCHF) (group 1, n=510) and patients who continued the follow-up in outpatient multidisciplinary clinics (OMC) at their place of residence (group 2, n=432). The clinical portrait of patients was evaluated after ADHF, and hemodynamic parameters were evaluated on discharge from the hospital. Also, the patient compliance with the treatment was analyzed during two years of follow-up. Statistical analysis was performed with Statistica 7.0 for Windows.Results    The leading causes for CHF included arterial hypertension, ischemic heart disease, atrial fibrillation, and type 2 diabetes mellitus. With the mean duration of hospitalization of 11 inpatient days, 88.1 % and 88.4 % of patients of groups 1 and 2 were discharged with complaints of shortness of breath; 62 % and 70.4 % complained of palpitations; and 73.6 % and 71.8 % complained of general weakness. On discharge from the hospital, the following obvious signs of congestion remained: peripheral edema in 54.3 % and 57.9 %; pulmonary rales in 28.8 % and 32.4 %; orthopnea in 21.4 % and 26.2 %; and cough in 16,5 % and 15.5 % of patients of groups 1 and 2, respectively. For the time of hospitalization, CHF patients did not achieve their targets of systolic BP (SBP), diastolic BP (DBP) and heart rate (HR). Patients of group 1 achieved the recommended values of SBP, DBP and HR already at one year of the follow-up at CCHF. Patients of group 2 had no significant changes in hemodynamic indexes. At one and two years of the follow-up, group 2 showed a considerable impairment of the compliance with the basis therapy for CHF compared to group 1.Conclusions    During the short period of hospitalization (11 inpatient days), the patients retained pronounced symptoms of HF and clinical signs of congestion and did not achieve their hemodynamic targets. The patients who were followed up for a long time at CCHF were more compliant with the basis therapy, which resulted in improvement of hemodynamic indexes, compared to the patients who were managed in OMS at the place of residence.

Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study.

Aim    To study the etiology and the dynamics of prevalence and mortality of CHF; to evaluate the treatment coverage of such patients in a representative sample of the European part of the Russian Federation for a 20-year period. Material and methods    A representative sample of the European part of the Russian Federation followed up for 2002 through 2017 (n=19 276); a representative sample of the population of the Nizhny Novgorod region examined in 1998 (n=1922).Results    During the observation period since 2002, the incidence of major CHF symptoms (tachycardia, edema, shortness of breath, weakness) tended to decrease while the prevalence of cardiovascular diseases has statistically significantly increased. During the period from 1998 through 2017, the prevalence of I-IV functional class (FC) CHF increased from 6.1 % to 8.2 % whereas III-IV FC CHF increased from 1.8 % to 3.1 %. The main causes for the development of CHF remained arterial hypertension and ischemic heart disease; the role of myocardial infarction and diabetes mellitus as causes for CHF was noted. For the analyzed period, the number of treatment components and the coverage of basic therapy for patients with CHF increased, which probably accounts for a slower increase in the disease prevalence by 2007-2017. The prognosis of patients was unfavorable: in I-II FC CHF, the median survival was 8.4 (95 % CI: 7.8-9.1) years and in III-IV FC CHF, the median survival was 3.8 (95 % CI: 3.4-4.2) years.

[Empagliflozin and heart failure: position paper of the experts on the results of the online meeting and discussion of the EMPEROR-Preserved Trial].

At an international online expert meeting held on September 16, 2021, the results of the empagliflozin research program EMPA-REG Outcome, EMPEROR-Reduced and EMPEROR-Preserved were reviewed. We analyzed cardiovascular and renal outcomes during the treatment with empagliflozin in patients with chronic heart failure, regardless of the presence of type 2 diabetes mellitus. The positive results of the EMPEROR-Preserved study are updated and their significance for clinical practice is discussed. Several proposals have been adopted that will accelerate the introduction of empagliflozin therapy into practice in patients with heart failure and overcome clinical inertia.

[Analysis of mortality in patients with heart failure after de-compen-sation during long-term follow-up in specialized medical care and in real clinical practice].

Background Mortality from chronic heart failure (CHF) remains high and entails serious demographic losses worldwide. The most vulnerable group is patients after acute decompensated HF (ADHF) who have a high risk of unfavorable outcome.Aim To analyze risks of all-cause death (ACD), cardiovascular death (CVD), and death from recurrent ADHF in CHF patients during two years following ADHF in long-term follow-up with specialized medical care and in real-life clinical practice.Material and methods The study successively included 942 CHF patients after ADHF. 510 patients continued out-patient treatment in a specialized CHF treatment center (CHFTC) (group 1) and 432 patients refused of the management in the CHFTC and were managed in out-patient clinics at the place of patient's residence (group 2). Causes of death were determined based on inpatient hospital records, postmortem reports, or outpatient medical records. Cases of ACD, CVD, death from ADHF, and a composite index (CVD and death from ADHF) were analyzed. Statistical analysis was performed with the software package Statistica 7.0 for Windows, SPSS, and statistical package R.Results Patients of group 2 were older, more frequently had functional class (FC) III CHF and less frequently FC I CHF compared to group 1. Women and patients with preserved left ventricular ejection fraction (LV EF) prevailed in both groups. Results of the Cox proportional hazards model for ACD, CVD, death from ADHF, and the composite mortality index showed that belonging to group 2 was an independent predictor for increased risk of death (р<0.001). An increase in CCS score by 1 also increased the risk of death (р<0.001). Baseline CHF FC and LV EF did not influence the mortality in any model. Female gender and a higher value of 6-min walk test (6MW) independently decreased the risk of all outcomes except for CVD. An increase in systolic BP by 10 mm Hg reduced risk of all fatal outcomes. At two years of follow-up in groups 2 and 1, ACD was 29.9 % and 10.2 %, (OR, 3.7; 95 % CI: 2.6-5.3; p <0.001), CVD was 10.4 % and 1.9 % (OR, 5.9; 95 % CI: 2.8-12.4; p<0.001), death from ADHF was 18.1 % and 6.0 % (OR, 3.5; 95 % CI: 2.2-5.5; p<0.001), and the composite mortality index was 25.2 % and 7.7 % (OR, 4.1; 95 % CI: 2.7-6.1; р<0.001). Analysis of all outcomes by follow-up period (3 and 6 months and 1 and 2 years) showed that the difference between groups 2 and 1 in risks of any fatal outcome was maximal during the first 6 months.Conclusion The follow-up in the system of specialized medical care reduces risks of ACD, CVD, and death from ADHF. The first 6 months following discharge from the hospital was a vulnerability period for patients after ADHF. The CCS score impaired the prognosis whereas baseline LV EF and CHF FC did not influence the long-term prognosis after ADHF. Protective factors included female gender and higher values of 6MW and systolic BP.

[The risks of re-hospitalization of patients with heart failure with prolonged follow-up in a specialized center for the treatment of heart failure and in real clinical practice.]

Relevance The number of patients with functional class III-IV chronic heart failure (CHF) characterized by frequent rehospitalization for acute decompensated HF (ADHF) has increased. Rehospitalizations significantly increase the cost of patient management and the burden on health care system.Objective To determine the effect of long-term follow-up at a specialized center for treatment of HF (Center for Treatment of Chronic Heart Failure, CTCHF) on the risk of rehospitalization for patients after ADHF.Materials and Methods The study successively included 942 patients with CHF after ADHF. Group 1 consisted of 510 patients who continued the outpatient follows-up at the CTCHF, and group 2 included 432 patients who refused of the follow-up at the CTCHF and were managed at outpatient clinics at their place of residence. CHF patient compliance with recommendations and frequency of rehospitalization for ADHF were determined by outpatient medical records and structured telephone calls. A rehospitalization for ADHF was recorded if the patient stayed for more than one day in the hospital and required intravenous loop diuretics. The follow-up period was two years. Statistical analyses were performed using a Statistica 7.0 software for Windows, SPSS, and a R statistical package.Results Patients of group 2 were significantly older, more frequently had FC III CHF and less frequently had FC I CHF than patients of group 1. Both groups contained more women and HF patients with preserved ejection fraction. Using the method of binary multifactorial logit-regression a mathematical model was created, which showed that risk of rehospitalization during the entire follow-up period did not depend on age and sex but was significantly increased 2.4 times for patients with FC III-IV CHF and 3.4 times for patients of group 2. Multinomial multifactorial logit-regression showed that the risk of one, two, three or more rehospitalizations within two years was significantly higher in group 2 than in group 1 (2.9-4.5 times depending on the number of rehospitalizations) and for patients with FC III-IV CHF compared to patients with FC I-II CHF (2-3.2 times depending on the number of rehospitalizations). Proportion of readmitted patients during the first year of follow-up was significantly greater in group 2 than in group 1 (55.3 % vs. 39.8 % of patients [odd ratio (OR) =1.9; 95% confidence interval (CI), 1.4-2.4; р<0.001]; during the second year, the proportion was 67.4 % vs. 28.2 % (OR=5.3; 95 % CI, 3.9-7.1; р<0.001). Patients of group 1 were readmitted more frequently during the first year than during the second year (р<0,001) whereas patients of group 2 were readmitted more frequently during the second than the first year of follow-up (р<0.001). Total proportion of readmitted patients for two years of follow-up was significantly greater in group 2 (78.0 % vs. 50.6 %) (OR=3.5; 95 % CI, 2.6-4.6; р<0.001). Reasons for rehospitalizations were identified in 88.7 % and 45.9 % of the total number of readmitted patients in groups 1 and 2, respectively. The main cause for ADHF was non-compliance with recommendations in 47.4 % and 66.7 % of patients of groups 1 and 2, respectively (р<0.001).Conclusion Follow-up in the system of specialized health care significantly decreases the risk of rehospitalization during the first and second years of follow-up and during two years in total for both patients with FC I-II CHF and FC III-IV CHF. Despite education of patients, personal contacts with medical personnel, and telephone support, main reasons for rehospitalization were avoidable.

[Patients after acute decompensation of Heart Failure: adherence to self-monitoring and treatment depending on the mode of outpatient monitoring].

Aim      To evaluate compliance with self-monitoring and drug and non-drug treatment of patients after ADHF during the management at a specialized center for CHF treatment (CCHF) or in real-life clinical practice.Material and methods  The study included 942 CHF patients after ADHF. In two years, the entire sample of patients was retrospectively divided into 4 groups based on their compliance with the management at the CCHF: group 1, 313 patients who were managed at the CCHF continuously for two years; group 2, 383 patients who choose the management at district outpatient clinics after discharge from a hospital; group 3, 197 patients who visited the CCHF for one year but then stopped the management; and group 4, 49 patients who initially preferred the management at district clinics but then switched to constant management at the CCHF. Compliance with recommendations was analyzed by data of outpatient clinical records or by data of structured telephone calls for patients who did not visit the CCHF or did not follow the visit schedule. Statistics was performed with a Statistica 7.0 for Windows software package.Results Patients of groups 2 (72.4 %) and 3 (88.3 %) performed self-monitoring less frequently whereas patients of groups 1 (94.6 %) and 4 (87.8 %) performed self-monitoring more frequently (р1 / 3=0.01, р1 / 2<0.001, р1 / 4=0.07, р2 / 4=0.02, р2 / 3<0.001, р4 / 3=0.9). Patients of group 2 (58.1 %) performed self-monitoring of heart rate less frequently than patients of groups 1, 3, and 4 (90.7 %, 81.7 %, and 87.8 %; р1 / 3=0.003, р1 / 2<0.001, р1 / 4=0.5, р2 / 4<0.001, р2 / 3<0.001, and р4 / 3=0.3). Patients of group 2 performed body weight self-monitoring less frequently than patients of groups 1, 3, and 4 (78.6 %, 67.9 %, and 72.9 %; р1 / 3=0.008, р1 / 2<0.001, р1 / 4=0.4, р2 / 4=0.002, р2 / 3<0.001, and р4 / 3=0.5). Compliance with the diet and restriction of salt consumption was 32.3 % and 37.5 % in groups 1 and 4, and 24.9 % and 19.9 % in groups 2 and 3 (р1 / 3=0.002, р1 / 2=0.03, р1 / 4=0.5, р2 / 4=0.02, р2 / 3=0.2, and р4 / 3=0.009). Compliance with recommendations on physical rehabilitation was 44.7% in group 1, which was better than in groups 2, 3, and 4 (8.2 %, 21.6 %, and 9.1 %; р1 / 2<0.001, р1 / 3=0.0003, р1 / 4=0.002, р2 / 4=0.9, р2 / 3=0.0006, and р4 / 3=0.2). At the end of the second year of follow-up, the actual proportion of patients taking ACE inhibitors/angiotensin receptor antagonists was low in groups 2, 3, and 4 (43.2 %, 45 %, and 66.7 %) and satisfactory in group 1 (92.4 %; р1 / 2<0.001, р1 / 3<0.001, р1 / 4<0.001, р2 / 3=0.6, р2 / 4=0.05, and р3 / 4=0.05). Proportion of patients taking beta-blockers was greater in group 1 (97.2 %) than in groups 2, 3. and 4 (73.2 %, 71.1 %, and 90.5 %; р1 / 2<0.001, р1 / 3<0.001, р1 / 4=00.08, р2 / 3=0.6, р2 / 4=0.1, and р3 / 4=0.06). Patients of group 1 (96.2 %) showed good compliance with the mineralocorticoid receptor antagonist treatment compared to groups 2, 3, and 4 (58.8 %, 55.4 %, and 81.2 %; р1 / 2<0.001, р1 / 3<0.001, р1 / 4<0.001, р2 / 3=0.5, р2 / 4=0.1, and р3 / 4=0.Conclusion      Only scheduled management by a cardiologist of the specialized CCHF provided sufficient compliance with self-monitoring and drug and non-drug treatment of CHF during the long-term follow-up.

[The prognosis of patients with chronic heart failure, depending on adherence to observation in a specialized heart failure treatment center].

Actuality. The risk of death of patients with chronic heart failure (CHF) after acute decompensation of heart failure (ADHF) is directly related to the quality of the treatment of CHF after discharge from the hospital. In order to achieve the maximum effect of therapy in patients with CHF, experts in Europe and the USA recommend the creation of centers of specialized medical care for patients with CHF. Objective: to determine the risks of general, cardiovascular mortality and death from ADHF in patients with CHF during two years of observation, depending on their adherence to observation in a specialized center for the treatment of chronic heart failure (center CHF). Materials and methods. The study consistently included 942 patients with CHF after ADHF. The adherence of patients to follow up in center CHF was analyzed and 4 groups were distinguished: group 1 (n = 313) included patients who were observed continuously for two years; group 2 (n = 382) included patients who, after discharge, had never been observed in the center CHF; group 3 (n = 197) consisted of patients who were monitored at center CHF during the first year and then discontinued, and group 4 (n = 49) united patients who, when included in the study, abandoned observation, but after a year began to be constantly observed during the second year center CHF. Results. Statistically significant differences in age were registered only between groups 1 and 2 (69.6+9.9 and 71.8+11 years, respectively, р1/2=0.006). The overall mortality over the 2 years of follow-up was significantly higher in group 2 (32.4%) versus group 1 (1.2%, OR=3.8, 95% CI 2.5-5.7; p1/2<0.001 ); compared with group 3 (9.1%, OR=4.8, 95% CI 2.8-8.1; p2/3<0.001) and group 4 (8,2%, OR = 5.4, 95% CI 1.9-15.3; p2/4=0.0005). Cardiovascular mortality (CVM) for 2 years of follow-up was significantly higher in group 2 versus group 1 (8.1% and 1.3% of cases, OR=6.8, 95% CI 2.4-19.5; p1/2<0.001), as well as in comparison with group 3 (CVM 3% for 2 years, OR=2.8, 95% CI 1.1-6.8; p2/3=0.02). CVM in group 4 (6.1%) was 5 times higher in comparison with group 1 (OR=5.0, 95% CI 1.1-23.2; p1/4=0.02). The risks of death from ADHF over the 2 years of follow-up were significantly higher in group 2 (16.4%) compared with all groups: with group 1 (6.4%) OR=2.9, 95% CI 1.7-4, 9, p1/2<0.001; with group 3 (5.1%) OR=3.7, 95% CI 1.8-7.3, p2/3<0.001; and with group 4 (2%) OR=9.5, 95% CI 1.3-69.7, p2/4= 0.008. The combined endpoint (CVM and death from ADHF in 2 years of follow-up) was also significantly higher in group 2 (24.5%) compared with all compared groups: group 1 (7.7%), OR=3.9, 95% CI 2.4-6.3, p1/2<0.001; group 3 (8.1%), OR=3.7, 95% CI 2.1-6.5, p2/3<0.001; and group 4 (8.2%), OR=3.7, 95% CI 1.3-10.4; p2/4=0.01. Conclusion. Surveillance of patients with CHF after an episode of ADHF in a specialized center CHF, both for a long time (two years) and partially during the first year of observation, reduces the risk of all-cause death, CVM and death from ADHF.

City Center for the Treatment of Chronic Heart Failure: the organiza-tion of work and the effectiveness of treatment of patients with chronic heart failure.

Actuality. In the Russian Federation, there has been an increase in the number of patients with chronic heart failure (CHF) of the III-IV functional class, who are characterized by frequent development of acute decompensation of СHF and frequent repeated hospitalizations. This dictates the need to create a system of effective control over the conduct of drug therapy and physical rehabilitation after discharge from the hospital at the outpatient stage. OBJECTIVE: to identify the differences between the two strategies for monitoringatients with CHF after decompensation and to determine the effectiveness of treatment, rehabilitation measures and life prognosis depending on the observation in the system of the specialized City Center for Treatment of CHF (Heart failure clinic) and in real outpatient practice. MATERIALS AND METHODS: The study included 648 patients hospitalized with decompensation in the inpatient unit of the Center for Treatment CHF. Group 1 consisted of 412 patients who, after discharge, continued rehabilitation and follow-up in the outpatient department of the Center for Treatment CHF. Group 2-326 patients who, after discharge, preferred observation in another outpatient departments of Nizhny Novgorod. RESULTS: After 1 year of observation, the overall mortality rate in group 2 was 14.83 %, and in group 1-4.13 %, (odds ratio (OR) = 4.0, 95 % confidence interval (CI) 2.2-7.4; p <0.001). Cardiovascular mortality was also higher in group 2: 11.4 % versus 3.3 % (OR = 3.8, 95 % CI 2.0-7.4; p <0.001), as well as mortality from decompensation: 7.6 % versus 2.1 % (OR = 3.8, 95 % CI 1.7-8.7; p <0.001). In group 2, non-fatal cardiovascular complications were more common: 5.1 % versus 1.6 % (OR = 3.2, 95 % CI 1.2-8.3; p = 0.01), as well as fatal and nonfatal stroke, pulmonary thromboembolism, venous thromboembolic complications - 6.3 % versus 1.4 % (OR = 4.4, 95 % CI 1, 7-11.6; p <0.001). An increase in the proportion of rehospitalized patients with CHF during the year in group 2 compared with group 1 was recorded: 50.3 % and 31.8 % of patients, respectively (OR = 2.2, 95 % CI 1.5-3.2; p<0.001). Physical activity of patients who were observed in Center for Treatment CHF the was significantly higher than among patients who were treated in another outpatient departments. CONCLUSION: Management of patients with CHF after decompensation in Heart failure clinic showed better results in comparison with the standard approach: the risks of general, cardiovascular mortality and nonfatal cardiovascular complications were statistically significantly lower. Patients with CHF who refused to be seen at Heart failure clinic were more often hospitalized again during the year.

[Stability of chronic heart failure from the position of a doctor and a patient: in search of contact points].

Actuality. The results of the EPOCH study showed that in 16 years in the Russian Federation the number of patients with chronic heart failure (CHF) of I-IV FC increased significantly. The main objectives of the treatment of CHF are the stabilization of the patient's condition and the reduction of the risks of cardiovascular mortality, decompensation and repeated hospitalizations for heart failure. But a single concept of "stable" CHF does not exist either in Russian or in foreign recommendations. OBJECTIVE: To assess how ofen the subjective assessment of a doctor regarding the stability of a patient with CHF coincides with the subjective opinion of the patient with CHF regarding the stability of his condition; and to identify those parametrs that have a leading influence on the assessment of the stability of the state from the point of view of the physician and the patient. MATERIALS AND METHODS: Data collection was carried out in the form of interviews among general practitioners and cardiologists in outpatient clinics (OC) of Nizhny Novgorod, which were randomly selected by the method of blind envelopes. In parallel, a survey was conducted of patients with CHF who applied for outpatient medical care about this syndrome to this OC, which the doctors were not informed about, because patient interviews were conducted after the end of outpatient admission in a separate room. Answers of doctors about a patient with CHF were compared with the answers of the corresponding patient; for this, a single code was assigned to both questionnaires. The study included 211 patients with CHF of any etiology older than 18 years. The study involved 25 doctors. The study was conducted from 11/01/17 to 11/30/17. RESULTS: Analysis of the data suggests that the doctor is more likely to consider the patient more stable in cases when the patient notes a decrease in the severity of shortness of breath, weakness and does not detect edema, while the fact of therapy with loop diuretics (LD) or an increase in them did not affect assessment of stability from the point of view of the doctor. From the point of view of the patient, the absence of the first three signs also testifies to the stability of the condition, however, unlike doctors, patients more often (p <0.001) considered themselves unstable in those cases when they needed LD therapy or an increase in LD dose. A logit regression analysis and ROC analysis based on selected signs and symptoms of CHF confirmed that a model that combines questions about persistent weakness and edema is best suited to predict the patient's subjective assessment of patient's stability from a doctor's point of view (61.8% of the results can be correctly predicted), and at the cutoff threshold of 0.5, it has the highest sensitivity of 64.9%. To predict the subjective assessment of stability in relation to the patient, the optimal model turned out to be the one that includes answers to the questions of "shortness of breath", "weakness" and "intake of loop diuretics", which allows to predict 66.7% of the results correctly at the cut­off threshold 0, 5 has a better balance of sensitivity and specificity (54.9 and 78.6, respectively). CONCLUSION: Reducing the severity of dyspnea, weakness and lack of edema of the lower extremities are important signs of the stability of the condition, both in the opinion of the doctor and in the opinion of the patient. Unlike the doctor, the patient is more likely to be classified as unstable in those cases when he is forced to receive therapy with loop diuretics at the outpatient stage or to increase their dose. The model for assessing the stability of a patient with CHF from the point of view of a physician more often allows one to confirm the patient's stable condition, while the model used by patients more often allows to identify patient instability and worsening of the course of CHF.

[Prognosis of the life of patients with chronic heart failure and atrial fibrilla-tion, depending on the control of hemodynamic parameters and tolerance to physical exertion in the background of basic therapy].

Actuality. In the basic therapy of CHF, drugs that reduce the pulse is one of the leading places. Target values of heart rate with sinus rhythm are established. Tere is still no consensus as to which heart rate is ideal in patients with CHF on the background of the rhythm of atrial fbrillation (AF). Te study of the prognosis in patients with CHF and AF depending on the achieved heart rate is relevant. OBJECTIVE: To analyze the overall mortality and establish the stratifcation risks of death in patients with CHF and AF depending on the form of AF, functional class of CHF and the presence of tachycardia. MATERIAL AND METHODS: A prospective cohort study was conducted in a group of patients with CHF who were observed at the City Center for CHF treatment (n = 591) during the year. Of these, 47.4% of patients had CHF and AF (n = 280) and 52.6% of patients with CHF without AF (n = 311). RESULTS: In a year, a permanent AF registered among patients with CHF and AF in 55.4%, persistent - in 36.4%, and paroxysmal - in 8.2% of cases. In 12.2% of patients, the diagnosis of AF was frst diagnosed. According to functional class of CHF, LVEF, assessment of clinical assessment scale, the group with a permanent AF was signifcantly heavier than without AF. Te mortality of patients with tachycardia signifcantly increased as a function of the increase in CHF from I-II to III-IV class: from 3.6% to 14.9% in the group without AF (p=0.04), and in the group with paroxysmal and persistent AF from 6.7% to 25.9% (p = 0.043). Te presence of tachycardia increases the risk of death by 61%, and the transition to a heavier functional class is 4.9 times. With each increase in the clinical assessment scale exponent by 1 point, the mortality rate in the sample is increased by 16%. CONCLUSION: Heart rate is not an independent predictor of death, but in combination with functional class III-IV CHF tachycardia signifcantly worsens the prognosis.

[The notion of CHF course stability: Is it acceptable for Russian practice?]

AIM: To evaluate preparedness of physicians in real clinical practice to strive for stabilizing the course of CHF by control of clinical and hemodynamic indexes both in prevention of admission for decompensated CHF and following discharge from the hospital. MATERIALS AND METHODS: The study included 750 CHF patients with any NYHA FC who were admitted in emergency for decompensated CHF. All patients with CHF were followed up for a year after discharge from the hospital. Medical records of inpatients (MRIP) and outpatients (MROP) were analyzed including determination of clinical symptoms and administered doses of medicines. Changes in clinical parameters during a year were recorded. RESULTS: CHF decompensation was evident as pulmonary edema in 1.6% of cases and acute left ventricular failure in 18.5% of cases. All the rest of decompensated CHF cases included ascites or hyposarca (21.1%), or increased edema syndrome with unstable hemodynamics (58.5%). In MROPs, weight control was presented for 1.2% of patients. The composite index of effectively achieved control of hemodynamics and body weight was only 0.2%. Treatment effectiveness decreases due to absence of drug titration and switching therapies, which considerably impairs prognosis for patients. CONCLUSION: Outpatient physicians lack alertness for development of CHF decompensation, and control of hemodynamics and body weight of patients remains ineffective. Physicians are not prepared to achieve recommended doses of medicines, which provokes high risk of fatal outcome and/or rehospitalization.

[Effectiveness of control over hemodynamic indexes and prognosis for patients with CHF and atrial fibrillation in real-life clinical practice].

BACKGROUND: Earlier studies have demonstrated a high prevalence of atrial fibrillation (AF) in patients with CHF. It was noticed that tachycardia and hypotension provoked high risks for cardiovascular mortality. The presence of arterial hypertension (AH) in CHF patients also impairs life prognosis. AIM: To determine prognosis for patients based on the control of hemodynamic indexes and titration of pulse-slowing therapy in real-life clinical practice. MATERIALS AND METHODS: This prospective study with a one-year followup period included 580 patients after decompensated CHF who were discharged from the Municipal Center for Treatment of CHF. 46.9% of patients had AF. Patients with AF were divided into groups with paroxysmal and persistent AF (combined) and permanent AF. RESULTS: Among patients with CHF and AF, 56.3%, 38.6%, and 5.1% had permanent, persistent, and paroxysmal AF, respectively. Patients with permanent AF had a higher CHF FC. The FC was evaluated using the 6­min walk test and Clinical Condition Scale at baseline and after the one-year follow-up. Incidence of hypotension and tachycardia was higher in the group with permanent AF. In patients without AF, baseline systolic blood pressure (SBP) (139.5±24.5 mm Hg) was higher than in patients with any AF type (132.1±24.2 mm Hg, p.

[Time-related changes in prevalence of chronic heart failure and diabetes mellitus in Nizhny Novgorod Region between 2000 and 2017].

AIM: To determine time-related changes in prevalence, morbidity, and all-cause mortality of patients with CHF depending on the presence of DM in a representative sample of Nizhny Novgorod Region. MATERIALS AND METHODS: In 1998, a representative sample of Nizhny Novgorod Region was created, which included 1922 respondents. From 2000 through 2017, this sample was evaluated three times. Patients with CHF and DM were studied. RESULTS: For 17 years, prevalence of NYHA FC IV CHF increased from 6.88 to 9.1 % (р=0.04). Prevalence of NYHA FC III-IV CHF increased considerably from 1.2 % to 4.8 % (р.

[Anticoagulant therapy and prognosis in patients with CHF and AF in the setting of real-life clinical practice].

BACKGROUND: Prevalence of atrial fibrillation (AF) grows with the increase in CHF FC and reaches 45% in III-IV FC CHF. With an adequate anticoagulant (AC) therapy, the risk of thromboembolic complications does not significantly differ between patients with I-II FC and III-IV FC CHF. Of particular interest is studying administration of the anticoagulant treatment and correspondence between the SAMe-TT2R2 scale and actual TTR values in patients with CHF and AF in real-life clinical practice. AIM: Toanalyze the efficacy of anticoagulant therapy and prognosis in patients with CHF and AF in the setting of real-life clinical practice. MATERIALS AND METHODS: The study included 272 patients with CHF and AF who were discharged from the hospital where they had been treated for decompensated CHF and who were followed up as outpatients for a year. Efficacy of the AC therapy was evaluated; parameters of CHA2DS2-VASc, HAS-BLED, and SAMe-TT2R2 scales were calculated at baseline. TTR was computed to determine the maintenance time. RESULTS: Patients with CHF had permanent (56.3%), persistent (38.6%), or paroxysmal (5.1%) AF. The mean CHA2DS2-VASc score was 3.83±1.16 and the mean HAS-BLED score was 1.3±0.83. SAMe-TT2R2 scores were 0 for 1.6% of patients; 1 for 36.9%, and 2< for 61.5%. At baseline, one third of patients with CHF and AF received antiplatelet therapy (APT) and every forth patient received no therapy. At one year, 69.0% of patients took AC on a constant basis (р.

[Spectrophotometric study of the initial stage of lymphocyte transformation]. / Spektrofotometricheskoe issledovanie nachal'noi stadii aktivatsii limfotsitov.

Results are presented of temporal variations of light current which passed through mouse lymphocyte suspension at introduction of phytohemagglutinin mitogen or concentrated cell suspension on liquid surface. Based on comparing the calculated time of phytohemagglutinin molecules diffusion, velocity of lymphocyte precipitation and recorded time of the system response a hypothesis is advanced concerning the existence of an ordered structure formed by cells in suspension, and a relay--race transmission of surface disturbance deep into the volume.