ABSTRACT
AIM: To evaluate the impact of a decrease in glomerular filtration rate (GFR) on the prognosis of patients with chronic heart failure (CHF), to analyze real clinical practice regarding the frequency of prescribing pathogenetic therapy for CHF, achieving target dosages depending on the gradation of GFR in patients included in the CHF Register of the Tyumen region. MATERIALS AND METHODS: The analysis included medical data of 4077 patients (1662 men and 2415 women) with NYHA class I-IV CHF who underwent examination and treatment in medical organizations of the Tyumen region for the period from January 2020 to May 2023. Criteria for inclusion in the register: proven heart failure. Chronic kidney disease (CKD) was assessed by GFR calculated using the CKD-EPI formula (ml/min/1.73 m2). The primary end point was defined as death from all causes. RESULTS: GFR<60 ml/min/1.73 m2 was recorded in 34.6% of patients, more common in women (40.2 and 26.6%, respectively; p<0.001). When dividing patients into phenotypes according to LVEF, no statistically significant differences were found in the distribution of patients according to GFR. In patients with HFrEF and HFpEF GFR<45 ml/min/1.73 m2 was associated with an increased risk of meeting the endpoint. Analysis of prescribed pathogenetic therapy showed that in patients with HFrEF, the frequency of prescription of ACE inhibitors, â-blockers and MRA decreased (p=0.023, 006 and 0.01, respectively), and ARNI, on the contrary, increased with a decrease in GFR (p=0.026). In patients with HFpEF, a similar trend towards a decrease in the frequency of prescription of ACEIs and MCBs with a decrease in GFR (p<0.001) remained, but it was compensated by an inversely proportional increase in the frequency of prescription of ARBs (p<0.001). 100% of the target dosage is achieved in more than 90% of patients taking MRA across the entire LVEF range. While for â-blockers and ARNI/ACE/ARB the percentage of patients receiving the full therapeutic dosage of drugs is significantly lower. When analyzing target dosages of pathogenetic drugs, gradations of achieved doses were distributed evenly throughout the entire range of GFR. CONCLUSION: GFR<60 ml/min/1.73 m2 occurs in every 3 patients with CHF across the entire range of LVEF. A decrease in GFR worsens the prognosis of patients with both HFrEF and HFpEF, increasing in direct proportion with the severity of the stage of CKD. Inclusion of patients in the monitoring program within the framework of the CHF service allows the treatment to be significantly brought closer to optimal drug therapy, at the same time, certain efforts are required to overcome difficulties with titration to target dosages.
Subject(s)
Glomerular Filtration Rate , Heart Failure , Renal Insufficiency, Chronic , Humans , Female , Male , Heart Failure/physiopathology , Heart Failure/drug therapy , Heart Failure/epidemiology , Renal Insufficiency, Chronic/physiopathology , Renal Insufficiency, Chronic/epidemiology , Prognosis , Middle Aged , Aged , Russia/epidemiology , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Registries , Stroke Volume/physiologyABSTRACT
AIM: Based on data from the Russian REGION-MI registry, to characterize patients with myocardial infarction (MI) hospitalized in Russian hospitals, describe their historical, demographic, and clinical characteristics, and compare the results with the data of previous Russian and international registries of acute coronary syndrome. MATERIAL AND METHODS: REGION-MI is a multicenter prospective observational study. The follow-up period was divided into three stages: during the hospital stay, at 6 and 12âmonths after the inclusion in the registry. Demographic and historic data and information about the present case of MI were entered into the patient's individual record card. RESULTS: The median age of all patients was 63 years; 68% of patients were men. The mean age of women was older than that of men. Among all MI cases, 70% were ST-segment elevation myocardial infarction (STEMI). Patients with non-ST-segment elevation myocardial infarction (NSTEMI) were older and had more comorbidities than patients with STEMI. The median time from the first symptoms to ECG recording was two hours, and from the first symptoms to CAG 7 hours. CAG was performed in 91% of patients with STEMI and 84% of patients with NSTEMI. Stenting was performed in 69% of patients. Although many patients had a complicated cardiovascular history, at the time of admission only 31.5% of patients were taking at least one drug from the groups of antiplatelets, oral anticoagulants, statins, and beta-blockers. CONCLUSION: Patients with MI in the Russian Federation are younger than patients with MI in European countries. Among the clinical and historical characteristics, conspicuous is the presence of modifiable risk factors in many patients, as well as the presence of a previous diagnosis of ischemic heart disease. Furthermore, a small proportion of patients took statins, antiplatelet agents or anticoagulants at the outpatient stage, which indicates a great reserve of both primary and secondary prevention of cardiovascular diseases in the Russian Federation. The delayed seeking medical help is also noticeable, which indicates the need for increasing the public awareness of the symptoms of MI and the importance of timely hospitalization.
Subject(s)
Myocardial Infarction , Registries , Humans , Russia/epidemiology , Male , Female , Middle Aged , Prospective Studies , Myocardial Infarction/epidemiology , Aged , Electrocardiography , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/diagnosisABSTRACT
AIM: Based on data from the Russian REGION-IM registry, to study the features of reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI) in real-life clinical practice. MATERIAL AND METHODS: REGION-IM is a multicenter prospective observational study. The observational period is divided into 3 stages: during the stay in the hospital and at 6 and 12 months after inclusion in the registry. The patient's records contain demographic and history data; information about the present case of MI, including the time of the first symptom onset, first contact with medical personnel, and admission to the hospital; coronary angiography (CAG) data, percutaneous coronary intervention (PCI) data, and information about the thrombolytic therapy (TLT). RESULTS: Reperfusion therapy was performed in 88.9 % of patients with STEMI. Primary PCI (pPCI) was performed in 60.6 % of patients. The median time from the onset of symptoms to pPCI was 315 minutes [195; 720]. The median time from ECG to pPCI was 110 minutes [84;150]. Isolated TLT was performed in 7.4 %, pharmaco-invasive treatment tactics were used only in 20.9 % of cases. The median time from ECG to TLT (prehospital and in-hospital) was 30 minutes [10; 59], whereas the median time from ECG to prehospital TLT was 18 minutes [10; 39], and in 63 % of patients, TLT was performed more than 10 minutes after diagnosis. PCI followed TLT in 73 % of patients. CONCLUSION: The frequency of reperfusion therapy for STEMI in the Russian Federation has increased considerably in recent years. The high frequency of pPCI is noteworthy, but the timing of pPCI does not always comply with clinical guidelines. The results of this registry confirm the high demand for pharmaco-invasive strategies in real-life clinical practice. Taking into account geographical and logistical features, implementing timely myocardial reperfusion requires prehospital TLT. However, the TLT frequency in the Russian Federation is still insufficient despite its proven maximum effectiveness in the shortest possible time from the detection of acute MI.
Subject(s)
Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Myocardial Infarction/therapy , Myocardial Reperfusion , Registries , ST Elevation Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/drug therapy , Thrombolytic Therapy , Treatment OutcomeABSTRACT
AIM: To study the predictive capabilities of the MADIT-ICD Benefit Score calculator in assessing the benefit of implantable cardioverter defibrillator (ICD) placement for the primary prevention of sudden cardiac death (SCD). MATERIAL AND METHODS: This study included 388 patients with NYHA II-IV functional class chronic heart failure (CHF) with a left ventricular ejection fraction (LVEF) ≤35 % who underwent ICD placement for the primary prevention of SCD. Patients were followed up for two years to record the endpoints of first-time paroxysmal sustained ventricular tachyarrhythmia (VT) or non-arrhythmic death. RESULTS: According to the results of calculation with the MADIT-ICD Benefit Score calculator, 276 (71 %) patients had a high risk of VT (score ≥7) and 150 (39 %) had a high risk of non-arrhythmic death (score ≥3). 336 (94%) patients would benefit from an ICD: 148 (38 %) with a high level of probability and 218 (56 %) with a medium level of probability. According to the incidence of endpoints, VT episodes predominated in the low-ICD benefit group (36%), while the high-ICD benefit group had a relatively high incidence of non-arrhythmic death (12%). CONCLUSION: The results obtained for a cohort of Russian patients with CHF and reduced LVEF indicated that the use of the MADIT-ICD Benefit Score in routine clinical practice does not improve the stratification of SCD risk compared to the traditional approach to selecting patients with CHF for ICD based on the LVEF value.
Subject(s)
Defibrillators, Implantable , Heart Failure , Tachycardia, Ventricular , Humans , Stroke Volume , Ventricular Function, Left , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/therapy , Death, Sudden, Cardiac/epidemiology , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Heart Failure/diagnosis , Heart Failure/therapy , Heart Failure/complications , Defibrillators/adverse effects , Defibrillators, Implantable/adverse effects , Risk FactorsABSTRACT
This article presents the current relevance of preventive cardiology, substantiates the increasing importance of the prevention of cardiovascular diseases (CVD) to reduce mortality and the burden of CVD, including in the era of widespread use of modern high-tech methods and effective drug therapy for treating CVD in clinical practice. The article also addresses effectiveness of secondary prevention of CVD and approaches to its improvement. Particular attention is paid to the high importance of introducing into practice comprehensive programs for secondary prevention of CVD and cardiac rehabilitation. The principles of organizing such programs and their most important components are presented in detail.
Subject(s)
Cardiac Rehabilitation , Cardiology , Cardiovascular Diseases , Humans , Cardiovascular Diseases/prevention & controlABSTRACT
Ways for reducing mortality from cardiovascular diseases The article analyzes the possible ways to further reduce cardiovascular disease mortality in the Russian Federation by eliminating shortcomings and pitfalls, introducing known but not used opportunities, and new organizational and medical technologies based on the accumulated experience of "best practice".
Subject(s)
Cardiovascular Diseases , Cardiovascular System , Heart Failure , Humans , Cardiovascular Diseases/prevention & control , Russia/epidemiologyABSTRACT
Intraventricular septum rupture is a rare mechanic complication of myocardial infarction associated with high mortality. This case describes STEMI in recovered patient after COVID 19 associated pneumonia, which was complicated by ventricular septum rupture followed by cardiogenic shock. It was managed by percutaneous occluder implantation. The procedure was complicated by right ventricular wall rupture. Postmortem examination of myocardium showed the signs of inflammation infiltrate and myocyte necrosis, according to histopathological Dallas criteria diagnosis of COVID-19 associated myocarditis was established. The COVID-19 pandemic has contributed to increasing cardiovascular mortality. This is typically attributed to diminishing resources for timely and appropriate medical care, and patients' late presentations for fear of contracting the infection. Cardiovascular complication of COVID-19 may be another contributing factor. Further research is needed to improve our understanding of the mechanisms and long-term sequelae of myocardium damage in COVID-19, to optimize treatment strategy and subsequent follow-up in such patients.
Subject(s)
COVID-19 , Myocardial Infarction , Myocarditis , Ventricular Septum , Humans , Myocarditis/etiology , Myocarditis/complications , Pandemics , COVID-19/complications , COVID-19/diagnosis , Myocardial Infarction/complicationsABSTRACT
The annual mortality of patients with clinically pronounced symptoms of chronic heart failure in the Russian Federation reaches 26-29%, i.e., from 880 to 986 thousand patients with heart failure die in the country in one year, which is comparable to the population of a large city. Providing care for patients with heart failure places a heavy burden on the country's health care system, making a significant contribution to mortality rates, hospitalization rates, including readmissions, which in turn requires considerable costs. The article presents an overview of registry studies that are devoted to assessing the effectiveness of diagnostics, the completeness of examinations, as well as the adequacy of ongoing drug treatment.
Subject(s)
Heart Failure , Hospitalization , Humans , Chronic Disease , Heart Failure/diagnosis , Heart Failure/epidemiology , Heart Failure/therapy , Russia/epidemiologyABSTRACT
Aim To study associations between the risk of severe adverse cardiovascular outcomes (SACVO) and all-cause death with psychosocial risk factors (PS RFs), such as stress, anxiety and depressive symptoms, low level of education, low income, social isolation, and type D personality, in patients with arterial hypertension (AH) and ischemic heart disease (IHD) managed in primary health care institutions in a multi-year prospective study.Material and methods PS RFs were assessed in patients with AH or IHD, who participated in a multi-year prospective COMETA study, using the Hospital Anxiety and Depression Scale (HADS), DS-14 questionnaire, and a visual analogue scale (VAS) for assessment of stress level. Associations of PS FRs with SACVO and all-cause death after a 1.5-year follow-up were analyzed using multivariate Cox regression models.Results At 1.5 years after patients were included in the study, it was possible to obtain data for 2,538 patients (age at baseline, 66.6 ± 7.8 years, 28.1% men), 106 of whom died during that period. The incidence of SACVO was 40.0 per 1000 person-years. According to the results of multivariate regression analysis, a very high level of anxiety symptoms (HADS-A≥14) was significantly associated with SACVO (odds ratio (OR), 1.81; 95% confidence interval (CI), 1.04-3.15; p=0. 02). The composite endpoint that included all-cause death and/or SACVO was significantly associated with a high (VAS score ≥8) stress level (OR, 1.53; 95% CI, 1.00-2.33; p=0.04) and a very high (HADS-D≥14) level of depressive symptoms (OR, 2.11; 95% CI, 1.22-3.62; p=0.02). A low level of education adjusted for gender and age increased the likelihood of SACVO by 1.7 (95% CI, 1.19-2.43) times. No significant associations were found between the analyzed outcomes and type D personality or with social isolation.Conclusion In patients with AH or IHD, the presence of high-grade stress and severe depressive symptoms increased the likelihoods of all-cause death and SACVO while a low level of education and severe anxiety symptoms were associated with SACVO. The study results showed that PS RFs for cardiovascular diseases keep the PS RF prognostic significance in the conditions of modern treatment of AH and IHD. Due to the negative impact on the prognosis, PS RFs should be taken into account when taking measures for secondary prevention of AH and IHD.
Subject(s)
Coronary Disease , Hypertension , Myocardial Ischemia , Male , Humans , Middle Aged , Aged , Female , Prospective Studies , Depression/diagnosis , Depression/epidemiology , Depression/etiology , Follow-Up Studies , Outpatients , Hypertension/complications , Myocardial Ischemia/complications , Myocardial Ischemia/diagnosis , Myocardial Ischemia/epidemiology , Coronary Disease/complications , Coronary Disease/diagnosis , Coronary Disease/epidemiology , Anxiety/diagnosis , Anxiety/epidemiology , Anxiety/etiologyABSTRACT
AIM: To evaluate the relationship between the in-hospital mortality of patients with COVID-19 and the history of cardiovascular disease (CVD) using data from the Russian registry of patients with COVID-19. MATERIAL AND METHODS: This study included 758 patients with COVID-19 (403 men, 355 women) aged from 18 to 95 years (median, 61 years), successively hospitalized in the COVID hospital of the Chazov National Medical Research Center of Cardiology from April through June 2020. Death predictors were studied using single- and multivariate regression analyses with the SPSS Statistics, Version 23.0 software. RESULTS: During the stay in the hospital, 59 (7.8 %) patients with COVID-19 died, 677 (89.3 %) were discharged, and 22 (2.9 %) were transferred to other hospitals. The univariate regression analysis showed that the increase in age per decade was associated with a 92% increase in the risk of death [relative risk (RR), 1.92; 95% confidence interval (CI), 1.58-2.34; p <0.001], and an increase in the number of CVDs increases the risk of death by 71% (RR 1.71; 95% CI 1.42-2.07; p<0.001). The presence of one or more CVDs or specific diseases [atrial fibrillation, chronic heart failure (CHF), ischemic heart disease, myocardial infarction, history of cerebrovascular accidents], as well as diabetes mellitus were associated with a higher risk of fatal outcome during the hospitalization for COVID-19. The presence of any CVD increased the risk of in-hospital death by 3.2 times. However, when the model was adjusted for age and sex, this association lost its strength, and only the presence of CHF was associated with a 3-fold increase in the risk of death (RR, 3.16; 95 % CI, 1.64-6.09; p=0.001). Age was another independent predictor of death (RR, 1.05; 95 % CI, 1.03-1.08; p < 0.001). CONCLUSION: A history of CVD and the CVD number and severity are associated with a higher risk of death during the hospitalization for COVID-19; the independent predictors of in-hospital death are an age of 80 years and older and CHF.
Subject(s)
COVID-19 , Cardiovascular Diseases , Heart Failure , Myocardial Infarction , Male , Humans , Female , Aged, 80 and over , Cardiovascular Diseases/complications , Hospital Mortality , COVID-19/complications , Heart Failure/complications , Myocardial Infarction/complications , Risk FactorsABSTRACT
Dispensary observation of patients with coronary artery disease can significantly reduce the likelihood of cardiovascular complications onset. Active outpatient monitoring allows to correct the main risk factors for cardiovascular complications, to estimate the risk of unfavorable cardiovascular events onset and to identificate patients who will get benefit of coronary revascularization. The introduction of a comprehensive assessment of cardiovascular risk and the development of remote monitoring technologies will improve the long-term results of outpatient follow-up of patients with coronary artery disease at high cardiovascular risk.
Subject(s)
Coronary Artery Disease , Humans , Coronary Artery Disease/complications , Risk Factors , Treatment OutcomeABSTRACT
Aim To compare variables of transthoracic EchoCG for determining echocardiographic predictors and their prognostic role in the development of persistent paroxysmal ventricular tachyarrhythmias (VT) in patients with ischemic CHF who had been implanted with a cardioverter defibrillator (CD) for primary prevention of sudden cardiac death.Material and methods This single-site prospective study included 176 patients with CHF of ischemic origin aged 58.7±7.4 years with a left ventricular ejection fraction (LV EF) of 30â% [25; 34] % who had been implanted with CD. The follow-up duration was 24âmonths. The primary endpoint was a newly developed persistent paroxysm of VT (duration ≥30 sec) detected in the "monitored" VT area or a VT paroxysm that required electric treatment. The echocardiographic picture was evaluated by 28 variables. Statistical analysis was performed with the c2, Fisher's, and Mann-Whitney tests, and the one-factor logistic regression (LR). Prognostic models were developed with a multifactorial LR. The model accuracy was evaluated by 4 metrics: area under the ROC (AUC), sensitivity, specificity, and diagnostic efficacy.Results The primary endpoint was observed in 60 (34â%) patients. Mean time to a persistent VT episode was 19.2±0.8 months (95â% confident interval (CI): 17.5-20.8). Superior-inferior dimensions of the right and left atria (RA and LA, respectively) and the left atrial volume (LAv) were independent predictors for VT. The odds of VT development in patients of the study cohort increased with RAl ≥4.5âcm (odds ratio (OR), 1.6; 95â% CI: 1.4-1.9; Ñ=0.03), LAl ≥5.5âcm (OR, 2.5; 95â% CI: 1.01-6.1; Ñ=0.04), LAv ≥95âml (OR, 3.2; 95â% CI: 1.3-17.5; Ñ=0.01). A comprehensive analysis of echocardiographic variables proved the prognostic potential of LAv that was linearly associated with the development of VT. The metrics of the best prognostic model were AUC 0.7±0.07 with 95â% CI: 0.54-0.83; specificity, 20.9â%; sensitivity, 95.7â%; and diagnostic efficacy, 47â%.Conclusion This study allowed evaluation of capabilities of transthoracic EchoCG for predicting the probability of VT in patients with CHF of ischemic origin and reduced LV EF. It was shown that linear and volumetric atrial dimensions could be used for stratification of risk of VT and for determining the tactics for primary prevention of sudden cardiac death in this patient category.
Subject(s)
Defibrillators, Implantable , Tachycardia, Ventricular , Humans , Follow-Up Studies , Prospective Studies , Stroke Volume , Ventricular Function, Left , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/prevention & control , Death, Sudden, Cardiac/epidemiology , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Echocardiography , Primary Prevention , DefibrillatorsABSTRACT
Aim To study specific features of the parenteral anticoagulant therapy for acute myocardial infarction (MI) in the Russian Federation and to evaluate the consistency of the prescribed parenteral anticoagulant therapy with the effective clinical guidelines.Material and methods REGION-MI, the Russian rEGIstry for acute myOcardial iNfarction, is a multicenter observational study. This registry includes all patients admitted to hospitals with a documented diagnosis of ST-elevation acute MI (STEMI) and non-ST-elevation acute MI (NSTEMI) based on the criteria of the Forth Universal Definition of MI of the European Society of Cardiology. Risk of bleeding was assessed with the Academic Research Consortium for High Bleeding Risk (ARC-HBR) scale, and risk of major bleeding in patients with NSTEMI was additionally assessed with the CRUSADE scale.Results From November 01, 2020 through April 03, 2022, 5025 patients were included into the REGION-MI registry. At primary vascular departments, 70.5% of patients were administered unfractionated heparin (NFH); at regional vascular centers, 37.1â% of patients were administered NFH, 29.6â% enoxaparin, 20,2% NFH in combination with enoxaparin, 6.8â% fondaparinux, 4.2â% NFH in combination with fondaparinux, and 1.9â% nadroparin. At the prehospital stage, NFH was used as an anticoagulant support for the thrombolytic therapy (TLT) in 84% of patients, and low-molecular heparins (LMH) were used in 16â%. At the hospital stage, UFH was administered to 64.4â% of patients, and enoxaparin was administered to 23.9â% of patients. Among the patients who had undergone primary percutaneous coronary intervention (PCI), 40â% received NFH, 25â% enoxaparin, 22â% NFH in combination with enoxaparin, 7â% fondaparinux, and 4â% NFH in combination with fondaparinux. In conservative and invasive tactics of therapy for NSTEMI, NFH was also administered more frequently (43 and 43â%, respectively), followed by (according to frequency of administration) enoxaparin (36 and 34â%, respectively), NFH in combination with enoxaparin (10 and 16â%, respectively), fondaparinux (7 and 6â%, respectively), and NFH in combination with fondaparinux (3 and 1â%, respectively).Conclusion According to the Russian registry of acute MI, REGION-MI, with all strategies for the treatment of MI, parenteral anticoagulants are not prescribed in full consistency with clinical guidelines. The most frequently used parenteral anticoagulant is NFH. Despite the high efficacy and safety of fondaparinux, the frequency of its administration remains unjustifiably low not only in the Russian Federation but also in other countries. The same can be said about the administration of enoxaparin to patients who had received TLT. Attention should be paid to physicians' awareness of recent clinical guidelines, to minimize the prehospital treatment with parenteral anticoagulants, to limit this treatment to the TLT support, and to provide continuity between all stages of medical care.
Subject(s)
Myocardial Infarction , Non-ST Elevated Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Anticoagulants/therapeutic use , Enoxaparin/adverse effects , Heparin/adverse effects , Fondaparinux/therapeutic use , Non-ST Elevated Myocardial Infarction/chemically induced , Non-ST Elevated Myocardial Infarction/drug therapy , Treatment Outcome , Myocardial Infarction/diagnosis , Myocardial Infarction/drug therapy , Myocardial Infarction/epidemiology , Hemorrhage/chemically induced , ST Elevation Myocardial Infarction/drug therapyABSTRACT
The article is devoted to the analysis of changes in the role of causal and comorbid risk factors for two main types of heart failure with reduced and preserved ejection fraction over the previous 20 years. Within the same time interval, the dynamics of the prevalence and mortality for these clinical variants. Special attention is paid to a possible solution to the issue of the complexity of recording cases of diagnosis and treatment of chronic heart failure in outpatient and hospital practice.
Subject(s)
Heart Failure , Humans , Prevalence , Stroke Volume , Heart Failure/epidemiology , Heart Failure/etiology , Heart Failure/drug therapy , Ventricular Function, Left , Chronic Disease , PrognosisABSTRACT
Aim To study specific features of administering platelet P2Y12 receptor inhibitors to patients with myocardial infarction (MI) in real-life clinical practice; to reveal a possible inconsistency of the therapy with clinical guidelines; to evaluate the patients' compliance with the medication at the outpatient stage; and to outline major direction for improving quality of the antiplatelet treatment.Material and methods REGION-MI is a multicenter prospective, observational study. The observational period is divided into 3 stages: during the stay in the hospital and at 3 and 12 months following the inclusion into the registry. Information about the drug therapy (used at the time of hospitalization, administered before the hospitalization, received in the hospital, and prescribed at discharge from the hospital) was recorded in the patient's individual registration card. Information about the antiplatelet treatment at 6 months following enrollment into the study was obtain by phone.Results The study included 4 553 patients. Dual antiplatelet therapy was administered after MI to 94.4â% patients: clopidogrel was administered to 52â%, ticagrelor to 42.2â%, and prasugrel to 11 patients (0.2â%). Ticagrelor was administered significantly more frequently in ST segment elevation myocardial infarction (STEMI) than in NSTEMI, 45â% and 33â%, respectively (p<0.001); clopidogrel was also administered more frequently to patients with STEMI than with NSTEMI, 59â% and 50â%, respectively. According to ARC-HBR criteria, in MI and a high risk of bleeding, clopidogrel was administered more frequently than ticagrelor (p <0.001). Ticagrelor was significantly more frequently administered to patients with MI and a low risk of bleeding than to patients with a high risk (p<0.001). In STEMI and a low risk of bleeding, ticagrelor was administered somewhat more frequently than clopidogrel, 56â% and 44â%, respectively (Ñ<0.05). In NSTEMI and a low risk of bleeding, clopidogrel was administered more frequently than ticagrelor, 53â% and 47â%, respectively (p<0.05). At 6 months post-MI, 94â% of patients continued taking one of the P2Y12 inhibitors.Conclusion According to data of the REGION-MI registry, the frequency of administering P2Y12 inhibitors to patients with acute MI was high, and the patients' compliance with this therapy was high at 6 months following MI. Although ticagrelor (the most available drug of all powerful platelet P2Y12 receptor inhibitors) has been prescribed more frequently in the recent years, a definite reserve exists for increasing the frequency of its administration. This is particularly important with a low risk of bleeding and the absence of requirement for anticoagulants. Thus, the prognosis for MI patients can be considerably improved.
Subject(s)
Myocardial Infarction , Non-ST Elevated Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Anticoagulants/therapeutic use , Clopidogrel/therapeutic use , Hemorrhage/chemically induced , Hemorrhage/epidemiology , Humans , Myocardial Infarction/drug therapy , Myocardial Infarction/etiology , Non-ST Elevated Myocardial Infarction/chemically induced , Non-ST Elevated Myocardial Infarction/drug therapy , Percutaneous Coronary Intervention/adverse effects , Platelet Aggregation Inhibitors/adverse effects , Prasugrel Hydrochloride/adverse effects , Prospective Studies , Purinergic P2Y Receptor Antagonists/adverse effects , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/drug therapy , Ticagrelor/adverse effects , Treatment OutcomeABSTRACT
Aim To study the prevalence of hyperlipidemia in patients with myocardial infarction (MI) in the Russian Federation; to assess the compliance with clinical practice guidelines of the lipid-lowering therapy prescribed upon discharge from the hospital; and to determine the number of patients who are indicated for the combination lipid-lowering therapy to achieve the low-density lipoprotein cholesterol (LDL-C) goal.Material and methods REGION-MI is Russian rEGIstry Of acute myocardial iNfarction, a multicenter, retrospective and prospective observational study. The observation period was divided into 3 stages: observation during the stay in the hospital and at 6 and 12 months after the inclusion in the registry. Plasma total cholesterol (TC) and LDL-C were measured in all patients on admission. Evaluation of the prescribed lipid-lowering therapy included the intensity of the treatment.Results The study included 3 620 patients; 62.4 of them had hyperlipidemia on admission. Mean TC on admission was 5.29âmmol/l and LDl-C level was 3.35âmmol/l. Upon discharge, 95.4% of patients after myocardial infarction continued on or were prescribed statin therapy; ezetimibe was prescribed to 1.22% of patients. Patients with an extremely high level of LDL-C >5 mmol/l accounted for 10.7% of patients with hyperlipidemia. The target level of LDL-C ≤1.4 mmol/l cannot be achieved with the statin and ezetimibe combination therapy in these patients; drugs from the group of PCSK9 inhibitors are indicated for them.Conclusion According to the data of the Russian registry of acute myocardial infarction, REGION-MI, a high incidence of hyperlipidemia is observed in patients with acute MI. Despite multiple studies that have proven the importance of achieving a low LDL-C level and good tolerance and safety of ezetimibe and PCSK9 inhibitors, the prescription frequency of combination therapy remains unreasonably low. Results of a simulation study that was conducted in Sweden and the data of the REGION-MI registry showed that PCSK9 inhibitors as a part of the combination therapy are indicated for many patients. The combination therapy is presently the most powerful type of lipid-lowering treatment that allows, in most cases, achievement of the LDL-C goal.
Subject(s)
Anticholesteremic Agents , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Hyperlipidemias , Myocardial Infarction , Anticholesteremic Agents/therapeutic use , Cholesterol, LDL , Ezetimibe/therapeutic use , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hyperlipidemias/complications , Hyperlipidemias/drug therapy , Hyperlipidemias/epidemiology , Myocardial Infarction/complications , Myocardial Infarction/epidemiology , PCSK9 Inhibitors , Prevalence , Proprotein Convertase 9 , Retrospective Studies , Russia/epidemiologyABSTRACT
As life expectancy increases, cardiovascular disease (CVD) is increasingly associated with cognitive impairment and dementia. Cognitive impairment can be a complication of CVD, develop at the same time or earlier than CVD. Often, the preclinical period of neurodegenerative diseases accompanied by cognitive impairment lasts for decades and their relationship with CVD is not fully understood. Studies have to take into account a large number of factors that are often interconnected with each other, so the role and mechanisms of action of each of them in the long term is very difficult to prove. The combination of CVD and cognitive impairment requires special approaches to patient management.
Subject(s)
Cardiovascular Diseases , Cognitive Dysfunction , Neurodegenerative Diseases , Cardiovascular Diseases/complications , Cardiovascular Diseases/epidemiology , Cognitive Dysfunction/complications , Humans , Neurodegenerative Diseases/complications , Risk FactorsABSTRACT
Aim To study the practice of drug treatment of ischemic heart disease (IHD) and the consistency of this practice with the established guidelines.Material and methods Results of the Russian part of the EUROASPIRE V study were compared with the general European population of the study. At ≥6 mos. and <2 years after the discharge from the hospital, patients were invited to visit the site for an interview. The drug therapy recommended upon discharge and taken by patients in the long-term as well as the patients' compliance with the treatment were analyzed. In Russian centers, 699 patients were registered, and 399 of them visited the centers for the interview.Results Upon discharge from the hospital, patients of the Russian cohort and of the entire study population were prescribed acetylsalicylic acid or other antiplatelet drugs (99.2% and 94.1%, respectively); beta-blockers (87.2 and 81.6%, respectively); angiotensin-converting enzyme (ACE) inhibitors (69.9% and 61.1%, respectively); sartans (16.5% and 14.2â%, respectively); calcium channel blockers (19.3 and 19.4â%, respectively); nitrates (8.0% and 22.5â%, respectively); diuretics (31.1 and 32.5â%, respectively); statins (98.0% and 85.0â%, respectively); and anticoagulants (6.6 and 8.3â%, respectively). For the long-term treatment, patients of the Russian cohort and of the entire study population took antiplatelets (94.7â% and 92.5â%, respectively); beta-blockers (83.2% and 81.0â%, respectively); ACE inhibitors (60.2% and 57.3â%, respectively); sartans (19.3% and 18.4â%, respectively); calcium antagonists (21.1% and 23.0â%, respectively); nitrates (9.0% and 18.2â%, respectively); diuretics (31.8% and 33.3â%, respectively); statins (88.2% and 80.8â%, respectively); and anticoagulants (8.8% and 8.2â%, respectively). High intensity hypolipidemic therapy was prescribed to 54.0â% of patients in Russian centers and 60.3â% of patients in the entire study. Both Russian and international patients evaluated their compliance with the prescribed medication as high.Conclusion According to results of the EUROASPIRE V study as compared to earlier studies, the practice of drug therapy in Russian patients with IHD has significantly approached European indexes. Further optimization is possible by a more extensive use of high intense hypolipidemic treatment and antidiabetic drugs with a documented positive effect on prognosis of cardiovascular diseases.
Subject(s)
Coronary Disease , Myocardial Ischemia , Adrenergic beta-Antagonists , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Humans , Myocardial Ischemia/drug therapy , Myocardial Ischemia/epidemiology , Russia/epidemiologyABSTRACT
Prevalence of chronic heart failure (CHF) is continuously growing and is associated with increased incidence of hospitalizations, morbidity and mortality. Furthermore, the increase in the number of rehospitalizations results in greater expenses and worsening of quality of life. In order to decrease the number of unscheduled hospitalizations and the death rate, the outpatient care should be improved, which can be achieved by using telemedical technologies. The aim of this review was collection and analysis of currently available information about the use of telemonitoring for patients with CHF. A systematic search and analysis of reports published from 2010 through 2020 in Web of Science, Scopus, and PubMed/MEDLINE databases was performed.
Subject(s)
Heart Failure , Telemedicine , Chronic Disease , Heart Failure/diagnosis , Hospitalization , Humans , Quality of LifeABSTRACT
Aim To study features of diagnosis and treatment of acute myocardial infarction (AMI) in Russian hospitals, results of the treatment, and early and late outcomes (6 and 12 months after AMI diagnosis); to evaluate the consistence of the treatment with clinical guidelines; and to evaluate patients' compliance with the treatment.Material and methods The program was designed for 3 years, including 24 months for recruitment of patients to the study. The study will include 10,â000 patients hospitalized with a confirmed diagnosis (I21 according to ICD-10) of ST segment elevation acute myocardial infarction (MI) (STEMI) or non-ST segment elevation MI (NSTEMI) based on criteria of the European Society of Cardiology Guidelines on Forth Universal Definition of Myocardial Infarction (2018). The follow-up period was divided into three stages: observation during the stay in the hospital and at 6 and 12 months following inclusion into the registry. The primary endpoint included cardiac death, nonfatal MI during the hospitalization and after one-year follow-up. Secondary endpoints were 6-months and one-year incidence of repeated MI, heart failure, ischemic stroke, clinically significant hemorrhage, unscheduled revascularization after discharge from the hospital, and the proportion of patients who continue on statins, antiplatelet drugs, and drugs of other groups for 6 months and 1 year.Results The inclusion of patients into the registry started in 2020 and will continue for 24 months. By the time of the article publication (June, 2021), more than 2,000 patients will be included.Conclusion REGION-MI (Russian rEGIstry Of acute myocardial iNfarction) is a multicenter, retrospective and prospective observational cohort study that excludes any interference with the clinical practice. Results of the registry will help to analyze a real picture of medical care provided to patients with myocardial infarction and to schedule ways to improve the situation.