[Results of circulatory disease detection during prophylactic medical examination of the adult population: the first two years' experience].

AIM: To estimate circulatory diseases (CD) detection rates during prophylactic medical examination of the adult population and to define their association with mortality rates and the spread of risk factors. MATERIAL AND METHODS: The results of the 2013-2014 prophylactic medical examinations for CD in the adult population of the Russian Federation as a whole and its subjects were comparatively analyzed using the data of statistical reports and official medical statistics on morbidity and mortality in the adult population. RESULTS: The data of official statistical reports on the results of prophylactic medical examinations in 2013 (19.4 million) and 2014 (22.2 million) were analyzed. In 2013 and 2014, there were 85.9 and 82.7 CD cases per 1000 examinees, respectively. These years were marked by the detection of 50.0 and 46.2 hypertensive patients, 17.1 and 16.1 coronary heart disease (CHD) cases, and 11.5 and 11.2 cerebrovascular diseases (CVD) ones, respectively. In 2013 and 2014, most CD cases were caused by hypertension (58.4 and 57%, respectively). The proportion of CHD was 19.9 and 19.4% and that of CVD was 13.4 and 13.6%, respectively. CONCLUSION: The analysis carried out could provide evidence for the importance of continuous monitoring of prophylactic medical examination at the level of each specific healthcare facility for primary health care to improve its quality and completeness of diagnostic examination. The found interregional differences in the detection rate of CD call for detailed analysis and determination of their causes, which will ensure the preventive direction of a medical examination that is inextricably entwined with further active follow-up measures for patients having the identified diseases and a risk for their development.

[Identification of circulatory diseases and their risk during medical examination of an adult population: methodological aspects].

AIM: To study the efficiency of a methodology for the active detection of coronary heart disease (CHD) and cerebrovascular diseases (CVD) during medical examination and to determine the need and possible ways of its improvement. SUBJECTS AND METHODS: The medical examinations of 19.4 million people (94.6% of all the citizens who had undergone medical examinations in all the regions of Russia in 2013) were analyzed and the methodological aspects of identification of the circulatory diseases (CDs) that were induced by coronary and cerebral vessel atherosclerosis and had common risk factors, primarily CHD and CVD, were assessed. RESULTS: The medical examinations revealed 2,915,445 cases of CDs and their suspicions, during which its clinical diagnosis was established in 57.2%. The suspected disease requiring that its diagnosis should be further specified; off-medical examinations revealed hypertension in more than 770,000 cases, CHD in 232,000, and CVD in 146,000. The proportion of stable angina pectoris of all angina cases was much higher at a young age (25.6%) than at middle (15.6%) and elderly (11.3%) ages. Brachiocephalic artery stenoses were detected in almost 13,000 cases. According to the official health statistics, within the years preceding the introduction of large-scale medical examinations, there was a slight rise in new CD cases among the adult population of Russia, which was more significant in 2013 (according to the preliminary data) than in 2012. CONCLUSION: The methodology for the active detection of CDs through a two-step medical examination, which is used during a follow-up, makes it possible to substantially increase detection rates for CDs. There has been shown to be a need for the better quality and completeness of diagnostic examination in real practice.

[New clinical and organizational approaches to preventing cardiovascular diseases in the primary health care system].

The paper deals with the justification and description of clinical and organizational approaches to preventing cardiovascular diseases (CVD) in the primary health care system (PHCS) under the present conditions of health care modernization in Russia. It formulates the basic directions of systematic measures in integration strategies for the prevention of noncommunicable diseases (mainly CVD) at a federal level, in which practical measures are presented to improve a system for the early detection of high-risk individuals and to carry out measures for risk factor correction in PHCS, i.e. to implement high-risk strategies, including clinical and organizational approaches to reconstituting the medical prevention infrastructure in PHCS. This is favored by the new normative documents adopted by the Ministry of Health of Russia on the follow-up and prophylactic medical examinations of the adult population. The paper substantiates the objective need for such examinations and characterizes the main clinical and organizational approaches promoted in medical examinations, which is aimed at introducing the current science-based and economically expedient methods in the real practice of PHCS for the early identifications of atherosclerosis-induced major CVDs and, what is particularly important, a risk for their development. Prophylactic counseling as a compulsory component is first being introduced in medical examination procedures. The key clinical and organizational principle of effective CVD prevention in public health is the implementation of the relationship and continuity of preventive measures, which becomes realistic with the adoption of new regulations of clinical examinations, prophylactic medical examinations, and follow-ups. The improvement of CVD prevention is associated not only with the introduction of organizational innovation changes, but also with the need to create a prevention ideology in physicians at all levels. It is emphasized that a comprehensive approach and all integrated CVD prevention strategies both at the population level and in the PHCS facilities are the most efficient and cost-effective procedure to reduce premature deaths from CVD in the population and to improve the demographic situation in our country.

[The clinical picture and outcomes of myocardial infarction which developed in a multifield hospital].

The aim of the investigation was to study most frequent clinical variants of myocardial infarction (MI) onset at a multifield hospital, as well as some features of its course and outcomes in patients undergoing treatment at different departments. The study found that the onset of intrahospital MI was often atypical, and that atypical onset was most frequent in cases of myocardial necrosis in patients undergoing treatment in surgical and therapeutic departments. The clinical picture, ECG data, and outcomes were analyzed in patients with MI whose onset took place at different hospital departments. The study revealed that the course of atypical variants of intrahospital MI, especially in surgical and therapeutic noncardiological patients, was more severe than in patients of cardiological departments.

[Clinical and morphological characteristics and factors of prognosis of pulmonary thromboembolism].

Analysis of 146,521 autopsy protocols in Moscow in 2001-2005 showed that the incidence pulmonary thromboembolism (PTE) as a direct cause of death was 3.8-7%. PTE was not diagnosed during life in 20-28% of the patients who had died at hospitals and in 68-72% of those who had died at home. PTE was 2-3 times more common in females than in males, the age of the deceased patients was old and senile. The sources of PTE were thrombi of the leg deep veins (93.2%), small pelvic veins (3.4%), and right heart chambers (1.1%). Thrombophilic states were one of the main causes of the poor course and outcome of PTE. Based on the studies performed, an algorithm was developed for the diagnosis and treatment, which was successfully used at the N.N. Burdenko Main Military Clinical Hospital. The introduction of the results could reduce the incidence venous thrombosis from 39% to 17%, that of cava-filter thromboses from 24% to 3.7%, and recurrent TELA from 15% to 5.6%.

[Pulmonary arterial thromboembolism and thrombophilias: optimization of diagnostics and treatment].

The subjects of the study were 94 patients with pulmonary arterial thromboembolism (PATE). The prevalence of thrombophilic conditions (TC) among these patients was studied, and their role in the development of an unfavorable clinical course of PATE was evaluated. A three-year prospective study revealed that pre-thrombotic conditions had been diagnosed in 90% of PATE patients. There is a strong correlation between an unfavorable course of PATE and the presence of isolated or combined genetic mutations, or a combination of those with an increase of factor VIII level, and a high titer of cardiolipin antibodies with a mutation in factor V gene. Occurrence of PATE in patients less than 40 years of age who suffer from an idiopathic type of venous thrombosis and have a family background of thrombophilic conditions, which requires a detailed hematological examination, is a predictor of unfavorable course of PATE in the post-hospital period. Purposeful pharmaceutical correction of thrombophilic conditions lowers the frequency of venous thrombosis recurrence from 39% to 17%, the frequency of cava-filter thrombosis recurrence from 24% to 3.7%, and the frequency of PATE recurrence from 15% to 5.6%.

[The main reasons for late diagnosis and errors in the early period of treatment of intrahospital myocardial infarction in a general hospital].

The purpose of the study was to investigate the reasons for late diagnosis and late transfer of hospitalized patients with myocardial infarction (MI) to a specialized cardiological department. The study shows that the main reasons are an atypical clinical picture of MI and a low "infarct alert" of doctors of different specialties. The authors analyzed the fullness of urgent medical aid and the beginning of treatment in cases of intrahospital MI in patients being treated in different hospital departments. The analysis revealed the main objective and subjective factors that cause a low frequency of administration of thrombolytics, anticoagulants, and disaggregants.

[The role of non-invasive diagnostics of pulmonary embolism in the optimization of treatment].

177 patients with pulmonary embolism (PE) were examined to study the information value of transthoracal echoCG in early diagnostics of the disease, the possibility of noninvasive evaluation of its severity, and possibility of determining indications for thrombolytic therapy (TLT) on basis of such evaluation. The results show that the sensitivity of such a sign as elevation of pulmonary artery pressure (PAP) by 30 mmHg, is 95%, provided that the patient does not have severe or moderate concomitant diseases cousing PAP elevation (postinfarction cardiosclerosis, chronic obstructive lung disease, valvular diseases etc.). The specificity of this sign, vs the control group, was 5%. Thus, elevation of PAP in patients with clinical manifestations of PE and without concomitant pathology, is a highly informative symptom of acute PE. The sensitivity of the parameter of right ventricular (RV) dilatation was 85%, of paradoxial ventricular septum motion--54%. In patients with PE of various degree of severity and concomitant diseases, high sensitivity of the above-listed sonographic signs of RVoverload goes together with their low specificity, which is not higher than 25%. This does not allow evaluating the degree of embolism and determining indications for TLT in these patients on basis of echoCG data. The authors of the article have developed an algorithm of diagnostic and therapeutic measures in patients with suspected PE.