Kardiologiya最新文献

{"title":"Relationship Between the Biomarkers of Collagen Regulation and Echocardiography Parameters in Patients With Heart Failure With Preserved Ejection Fraction.","authors":"N E Shirokov, T N Enina, E V Zueva, E I Yaroslavskaya, D V Krinochkin, N A Musikhina, T I Petelina, L I Gapon","doi":"10.18087/cardio.2024.12.n2706","DOIUrl":"https://doi.org/10.18087/cardio.2024.12.n2706","url":null,"abstract":"<p><strong>Aim: </strong>To study the relationship between laboratory markers and echocardiography (EchoCG) parameters in heart failure with preserved ejection fraction (HFpEF) depending on the results of the diastolic stress test (DST).</p><p><strong>Material and methods: </strong>The diagnostic algorithm provided by the current guidelines for the assessment of left ventricular (LV) diastolic function was used to select patients. If there were not enough criteria to make a conclusion about increased LV filling pressure (FP) based on standard resting echocardiography data in patients with arterial hypertension and ischemic heart disease, DST was performed to detect HFpEF. 80 patients (50.0% men, mean age 66.3±5.4 years) were included. Group 1 consisted of 41 patients with a positive DST, and group 2 included 39 patients with a negative DST. Concentrations of the markers of immune inflammation, endothelial dysfunction, collagen homeostasis, and myocardial stress were measured.</p><p><strong>Results: </strong>The DST showed significant differences in the E/e' ratio (15.1 [13.4; 15.9] in group 1 and 9.5 [7.9; 10.3] in group 2, respectively, p&lt;0.001) and the diastolic functional reserve index (DFRI) (9.8 [6.8; 14.0] and 21.0 [13.0; 29.0], p &lt; 0.001). Resting EchoCG revealed significant differences in the left atrial reservoir strain (LASr) (22.8 [19.6; 25.6]% and 28.0 [24.8; 30.2]%, p&lt;0.001) and the left atrial stiffness index (LASI) (0.50 [0.40; 0.57] and 0.34 [0.27; 0.41], p&lt;0.001). In patients with HFpEF, the laboratory parameters of collagen regulation had the greatest number of relationships. Correlations were found between the concentrations of matrix metalloproteinase-9 and other biomarkers, including interleukin-10 (IL-10) (r=0.311; p=0.048), myeloperoxidase (r=0.382; p=0.014), N-terminal propeptide of procollagen type I (procollagen I N-terminal propeptide, PINP) (r=0.722; p&lt;0.001) and type III (r=0.591; p&lt;0.001), C-terminal propeptide of procollagen type I (r=0.330; p=0.035), tissue inhibitor of metalloproteinases type 1 (r=0.410; p=0.008), EchoCG parameters, including left atrial volume index (LAVI) (r=0.414; p=0.007) and DFRI (r=0.354; p=0.025). In addition, correlations were found for the concentrations of PINP with IL-10 (r=0.401; p=0.009) and endothelin-1 (r= -0.337; p=0.031); PINP with LAVI (r=0.498; p=0.001) and DFRI (r=0.420; p=0.007).</p><p><strong>Conclusion: </strong>Patients with HFpEF have a greater number of relationships between markers of collagen homeostasis disorders and EchoCG parameters characterizing an increase in LV FP.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 12","pages":"51-58"},"PeriodicalIF":0.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Frequency of Occurrence of Cardiovascular Risk Factors and Awareness оf Them Among Young People in Higher Education Institutions.","authors":"A G Plisyuk, Ia A Orlova, E I Zimakova, Yu L Begrambekova, E S Krasilnikova, I S Daudov, S E Evlampiev, O M Nesuk, A G Armaganov, Zh A Akopian, A A Kamalov","doi":"10.18087/cardio.2024.12.n2724","DOIUrl":"https://doi.org/10.18087/cardio.2024.12.n2724","url":null,"abstract":"<p><strong>Objective: </strong>To assess the prevalence of risk factors  of cardiovascular disease (CV RF) development and awareness of them among young people studing at University.</p><p><strong>Material and methods: </strong>Сross-sectional study study included 1182 young men and women studying at Lomonosov Moscow State University (age 18-44 years), with no history of chronic non-infectious diseases, who underwent a screening  in April-June 2022. All participants filled out the standard \"Questionnaire for citizens under the age of 65 years to identify chronic non-communicable diseases, risk factors for their development, and the use of narcotic drugs and psychotropic substances without prescription\", a specially designed questionnaire on socio-demographic characteristics and risk factors for CVD development, and a questionnaire on nighttime sleep status. Results. In young men, the most common FRs were low fruit and vegetable intake (46.8%). Sleep disturbances were reported by 28.8% of men and 34.5% of women. Low physical activity was present in 1 in 5 young people. Obesity was found in 5.0% of the study participants. Young women in general showed greater awareness of CV RF. The most frequent factor mentioned in the questionnaire was smoking. More than 60% of respondents mentioned low physical activity and  nutritional factors , while obesity and overweight were mentioned by only 16% of respondents.More CV RFs were named by natural science students, and more smokers were identified among them.</p><p><strong>Conclusion: </strong>The obtained data allow us to speak about the high prevalence of behavioral CV RFs  and insufficient awareness of their adverse health effects in young people, even with a high level of education. The effectiveness of preventive measures can be largely determined by their precise targeting. Raising awareness of the need for greater consumption of fruits and vegetables, sleep norms, the dangers of arterial hypertension, hypodynamia and obesity, in our opinion, is an important component of preventive work among students in universities.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 12","pages":"19-26"},"PeriodicalIF":0.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cumulative Incidence and Prognostic Value of Readmissions in Patients With Heart Failure: Data From a Large Cohort Study of Real Clinical Practice in St. Petersburg.","authors":"A E Soloveva, T V Gorbacheva, A E Solovev, S V Villevalde, N E Zvartau, E V Shlyakhto","doi":"10.18087/cardio.2024.11.n2781","DOIUrl":"https://doi.org/10.18087/cardio.2024.11.n2781","url":null,"abstract":"<p><p>Aim    To evaluate the cumulative incidence and prognostic value of rehospitalizations in patients with heart failure (HF) within one year after discharge.Material and methods    The data of patients with HF hospitalized for the first time (code I50.x in the diagnosis) for the period from January 01, 2022 through February 13, 2024 were selected from the St. Petersburg Chronic Heart Failure Registry. Age and gender characteristics, comorbidities, risk of rehospitalization and death after discharge from the hospital depending on the number of rehospitalizations were analyzed. Descriptive statistics methods, Kaplan-Meier survival analysis, and the Fine and Gray competing risks model were used. P&lt;0.001 was considered significant.Results    The study included 43,143 patients with HF who were hospitalized for the first time. During a median observation time of 242 days, 6,395 (14.8%) patients were readmitted, most often once (78.4%). A greater number of rehospitalizations was typical for men, patients with HF of ischemic genesis, atrial fibrillation, diabetes mellitus, obstructive pulmonary diseases, and a history of COVID-19. The cumulative incidence of rehospitalizations for HF during 1, 3, 6, and 12 months was 3.2%, 7.0%, 10.8%, and 17.2%, respectively, taking into account the competing risk of death. With an increasing number of hospitalizations, the median time to the next hospitalization decreased, and the risk of readmission increased (p&lt;0.001). The probability of death within a year of the index hospitalization was 14.9% (95% confidence interval [CI]: 14.5%-15.3%). The all-cause death rate was 30, 44, and 54 cases per 100 patient-years for patients with one, two, and at least three readmissions vs. 19 cases per 100 patient-years for those without readmissions. Readmitted patients were characterized by an increased risk of death: the adjusted hazard ratios of death in patients with one, two, and at least three readmissions were 1.47 (95% CI: 1.36-1.59), 1.97 (95% CI: 1.69-2.30), and 2.24 (95% CI: 1.81-2.78), respectively.Conclusion    In patients hospitalized with HF for the first time, the cumulative one-year HF readmission rate adjusted for the competing risk of death was 17.2%. Increased readmission rates were independently associated with increased odds of readmission and death.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 11","pages":"96-105"},"PeriodicalIF":0.5,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Ventricular Remodeling Predictors in Chronic Heart Failure of Ischemic Etiology.","authors":"A A Ageev, M V Kozhevnikova, D A Tyurina, E O Korobkova, T O Kondratieva, K M Shestakova, N E Moskaleva, P A Markin, N V Khabarova, S A Appolonova, Yu N Belenkov","doi":"10.18087/cardio.2024.11.n2794","DOIUrl":"https://doi.org/10.18087/cardio.2024.11.n2794","url":null,"abstract":"<p><p>Aim      To identify metabolomic and structure and function markers of remote left ventricular (LV) remodeling in patients with chronic heart failure (CHF) of ischemic etiology and LV ejection fraction (EF) &lt;50%.Material and methods  This prospective study included 56 patients with 3-4 NYHA functional class CHF of ischemic etiology (mean age, 66±7 years) and 50 patients with ischemic heart disease (IHD) without signs of CHF (69 [64; 73.7] years). Concentration of 19 amino acids, 11 products of kynurenine catabolism of tryptophan, 30 acylcarnitines with different chain lengths were measured in all participants. The metabolites that showed statistical differences between the comparison groups were then used for the analysis. Echocardiography was used to assess LV cavity remodeling at the time of the CHF patient inclusion in the study and after 6 months of follow-up. Predictors of long-term LV cavity remodeling were assessed for this cohort taking into account statistically significant echocardiographic parameters and metabolites.Results Patients with CHF of ischemic etiology, predominantly (81%) had pathological calculated types of LV remodeling (concentric and eccentric hypertrophy, 46 and 35%, respectively). However, this classification had limitations in describing this cohort. In addition, in this group, the concentrations of alanine, proline, asparagine, glycine, arginine, histidine, lysine, valine, indolyl-3-acetic acid, indolyl-3-propionic acid, C16-1-OH, and C16-OH were significantly (p&lt;0.05) lower, and the concentrations of most medium- and long-chain acylcarnitines were higher than in patients with IHD without signs of CHF. The long-term (6 months) reverse remodeling of the LV cavity in CHF of ischemic etiology was influenced by changes in the interventricular septum thickness (hazard ratio, HR, 19.07; 95% confidence interval, CI, 1.76-206.8; p=0.006) and concentrations of anthranilic acid (HR 19.8; 95% CI 1.01-387.8; p=0.019) and asparagine (HR 8.76; 95% CI 1.07-71.4; p=0.031).Conclusion      The presence of an interventricular septum thickness of more than 13.5 mm, anthranilic acid concentrations of higher than 0.235 μM/l, or an asparagine concentration of less than 135.2 μM/l in patients with CHF of ischemic etiology after 6 months of follow-up affects their achievement of LV cavity reverse remodeling.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 11","pages":"106-116"},"PeriodicalIF":0.5,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship of Iron Deficiency, Anemia and Combination of Iron Deficiency With Anemia With Severity of Manifestations of Chronic Heart Failure. Additional Analysis of the Study \"Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (J-CHF-RF)\".","authors":"V Yu Mareev, Zh D Kobalava, Yu V Mareev, Yu L Begrambekova, L V Karapetyan, S A Galochkin, E R Kazakhmedov, A A Lapshin, A A Garganeeva, E A Kuzheleva, A A Efremushkina, E V Kiseleva, O L Barbarash, T B Pecherina, A S Galyavich, Z M Galeeva, L V Baleeva, N A Koziolova, A S Veklich, D V Duplyakov, M N Maksimova, S S Yakushin, E A Smirnova, E V Sedykh, I I Shaposhnik, N A Makarova, A A Zemlyanukhina, V V Skibitskiy, A V Fendrikova, A V Skibitskiy, N A Spiropulos, E M Seredenina, Ya A Orlova, K A Eruslanova, Yu V Kotovskaya, O N Тkacheva, M A Fedin","doi":"10.18087/cardio.2024.11.n2786","DOIUrl":"10.18087/cardio.2024.11.n2786","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Aim      To evaluate the role of iron deficiency (ID) identified by various criteria, anemia, and the combination of ID and anemia in determining the severity of the clinical course of chronic heart failure (CHF) in a retrospective analysis of data from 498 patients who participated in the ID-CHF-RF Russian multicenter program.Material and methods  ID was diagnosed by the following three criteria established by the European Society of Cardiology (ESC) and the Russian Society of Cardiology (RSC): 1) ferritin concentration &lt;100 μg/l or ferritin concentration 100-299 μg/l in combination with a decreased transferrin saturation (TS) &lt;20%; 2) ID criteria that showed a high sensitivity and specificity when compared with bone marrow morphology (BMM): TS ≤19.8% or serum iron (SI) ≤13 μmol/l; and 3) a composite index including a ferritin concentration &lt;100 μg/l in combination with TS &lt;20% and SI ≤13 μmol/l. The presence of anemia was defined as a hemoglobin concentration of less than 12.0 g/dl in women and less than 13.0 g/dl in men according to the criteria of the World Health Organization.Results Concomitant anemia was detected in 40.3% of patients with CHF; in 85.1% of cases, anemia was combined with the SI concentration below normal. CHF patients with concomitant anemia were significantly older and had low levels of not only red blood cells and hemoglobin but also all parameters of iron metabolism, i.e., SI, ferritin concentration, and TS. The mean deviation of the red blood cell size, that characterizes the degree of anisocytosis, was significantly increased in patients with anemia, especially with a low SI. These patients had a higher CHF functional class, elevated levels of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) and walked a shorter distance in the 6-minute walk test, which reflects significantly more severe manifestations of CHF with concomitant anemia, particularly in combination with a low SI. The incidence of ID was 83.1% (including 23.3% in combination with anemia) according to the ESC/RSC criteria; 74.5% (including 43.3% with anemia) according to the BMM criteria; and 51.6% (including 51.7% with anemia) according to the composite index, which seems to be stricter compared to the first two criteria. Regardless of the assessment method (by total weighted average data), in ID combined with anemia, not only the hemoglobin concentration was significantly reduced but all three analyzed parameters of iron metabolism were also significantly reduced (SI 9.0 μmol/l vs. 10.4 μmol/l; ferritin 41 μg/l vs. 59 μg/l; TS 8.5% vs. 12.9%) compared to ID without anemia, respectively. The CHF severity and the NT-proBNP concentration were also maximum for the combination of ID and anemia, in contrast to ID without anemia, regardless of the ID criterion used. A more accurate comparison of the methods for determining ID in CHF in the context of their prognostic value will be obtained by analyzing the data of a two-year foll","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 11","pages":"62-75"},"PeriodicalIF":0.5,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The Role of the Left Atrium in the Pathogenesis of Heart Failure With Preserved Ejection Fraction].","authors":"A G Ovchinnikov, A V Potekhina, A Yu Filatova, O N Svirida, M Kh Shogenova, M S Sobolevskaya, F T Ageev","doi":"10.18087/cardio.2024.11.n2799","DOIUrl":"https://doi.org/10.18087/cardio.2024.11.n2799","url":null,"abstract":"<p><p>Left atrial dysfunction (left atrial myopathy) is not only a consequence of impaired left ventricular diastolic function but also plays a central role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). Left atrial myopathy in HFpEF is associated with a more severe course of heart failure and an unfavorable prognosis, and the choice of treatment largely depends on its severity. Echocardiography allows an accurate assessment of the left atrial condition, while the parameters of left atrial myocardial strain are sensitive to early functional disorders to help diagnosing HFpEF and determining the prognosis. This article discusses the participation of the left atrium in the left ventricular filling, its status at different stages of left ventricular diastolic dysfunction, the major mechanisms of atrial myopathy in HFpEF, and therapeutic approaches to its restriction and reversion.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 11","pages":"132-147"},"PeriodicalIF":0.5,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Principles of Outpatient Care of Patients With Heart Failure].","authors":"O M Drapkina, A I Chesnikova","doi":"10.18087/cardio.2024.11.n2797","DOIUrl":"https://doi.org/10.18087/cardio.2024.11.n2797","url":null,"abstract":"<p><p>These guidelines combine the key provisions for the management of patients with chronic heart failure (CHF) at the outpatient stage based on current data from clinical studies, new 2024 clinical guidelines of the Russian Society of Cardiology for the management of CHF patients, and the provisions of the current order of the Ministry of Health of the Russian Federation on the procedure for conducting dispensary observation. CHF is a progressive disease characterized by a high risk of death, rehospitalizations, and disability. Reducing the risk of CHF decompensation and improving the prognosis is possible only with regular monitoring of the patient's condition and timely correction of therapy. The priority task of the outpatient unit is to expand the coverage of dispensary follow-up of CHF patients, preventive counseling, and telemedicine monitoring for timely identification of the patients at a high risk of CHF progression, improving their quality of life, and prolonging their life duration.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 11","pages":"148-156"},"PeriodicalIF":0.5,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Results of Revascularization for Acute Coronary Syndrome in 2023.","authors":"B G Alekyan, S A Boytsov, E M Manoshkina, N A Kochergin, V I Ganyukov","doi":"10.18087/cardio.2024.11.n2733","DOIUrl":"https://doi.org/10.18087/cardio.2024.11.n2733","url":null,"abstract":"<p><p>Aim    To analyze the results of myocardial revascularization in the Russian Federation (RF) for ACS in 2023 compared to previous years.Material and methods    The analysis included the number of cases of ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation acute coronary syndrome (NSTE-ACS), myocardial revascularization in the above-listed ACS forms, the number of fatal outcomes depending on the ACS form and the revascularization method used. The data for this analysis were obtained from the 2023 Ministry of Health of Russia monitoring in the section of revascularization in ACS and were compared with the data for the past 8 years.Results, conclusion   In 2023, 438,315 patients were hospitalized for ACS in the Russian Federation: 309,158 with NSTE-ACS and 148,729 with STEMI. The total number of hospitalizations for ACS per 1 million of the Russian population was 2,982: 1,011 with STEMI and 2,103 with NSTE-ACS. The availability of primary PCI in 2023 reached its maximum of 55.3% compared to previous years; the total number of PCI for STEMI was 75.7%, and the mortality rate in the whole STEMI group was a minimum of 10.7% for the past 8 years. In 2023, the maximum number of PCIs for NSTE-ACS for the past 8 years was recorded, both in absolute values (120,990) and in relative values (39.1%). In the whole NSTE-ACS group, mortality was 2.5%, which was also the lowest for the past 8 years.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 11","pages":"76-83"},"PeriodicalIF":0.5,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[EPOCH-CHF As A Mirror of the Current Problems in Cardiovascular Diseases Treatment in Real Clinical Practice].","authors":"I V Fomin, Yu N Belenkov, V Yu Mareev, F T Ageev, E G Artemyeva, Yu V Badin, E V Bakulina, A R Weisberg, N G Vinogradova, A S Galyavich, T S Ionova, G M Kamalov, S G Kechedzhieva, N A Koziolova, V Yu Malenkova, S V Malchikova, D S Polyakov, E A Smirnova, E I Tarlovskaya, E V Shcherbinina, S S Yakushin","doi":"10.18087/cardio.2024.11.n2808","DOIUrl":"https://doi.org/10.18087/cardio.2024.11.n2808","url":null,"abstract":"<p><p>Aim    To analyze the main reasons for the impairment of the life prognosis of patients with chronic heart failure (CHF) in real clinical practice of the Russian Federation.Material and methods    Representative samples of the population of the Nizhny Novgorod region (1998, n=1,922) and the European part of Russia followed from 2002 through 2017 (n=19,276), as well as randomly selected medical records of outpatients under the dispensary monitoring for CHF from 19 therapeutic and preventive medical institutions of three constituent entities of the Russian Federation (n=177, 2022) were analyzed for the adherence to therapy and the effectiveness of treatment. In addition, the prevalence, etiology, and prognosis of life of patients with CHF and acute decompensated heart failure (ADHF) were determined as a part of the EPOCH study.Results    The EPOCH-CHF study for the first time determined the true prevalence of CHF in the European part of the Russian Federation (8.2% by soft criteria) and 3.1% (by strict criteria). Furthermore, the prevalence of heart failure with reduced ejection fraction (EF) was 0.8%, moderately reduced EF was 0.9%, and heart failure with preserved EF was 1.4% of all studied patients in whom HF was defined by strict criteria. The EPOCH-CHF and EPOCH-Hospital Stage studies confirmed that a long-term exposure of the body to arterial hypertension and ischemic heart disease significantly influenced the development of CHF. At the same time, acute myocardial infarction, diabetes mellitus and uncorrected heart defects can induce severe CHF within a short period. The life prognosis of patients both after ADHF and with stable CHF in the Russian Federation is very poor. Within 4 years, 55.2% of patients after ADHF die; no patient with III-IV FC CHF survives longer than 10 years; and patients with I-II FC CHF are at a 75% risk to die after 16 years of follow-up. This is related with an ineffective use of basic drugs and uncoordinated follow-up of patients.Conclusion    The analysis of three studies showed a high level of coverage of CHF patients with therapy but a low level of compliance with national guidelines, which is reflected in the use of low doses of drugs, the lack of effective hemodynamic control and, as a consequence, a poor prognosis for CHF patients with CHF, regardless of its stable course or acute decompensation.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 11","pages":"48-61"},"PeriodicalIF":0.5,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient With Chronic Heart Failure as a Participant in the Treatment Process: the Role of Structured Training And Outpatient Observation (on the Anniversary of the Study Chance).","authors":"Yu N Belenkov, V Yu Mareev, F T Ageev, Yu L Begrambekova","doi":"10.18087/cardio.2024.11.n2779","DOIUrl":"10.18087/cardio.2024.11.n2779","url":null,"abstract":"<p><p>Aim      The article presents the principal results and conclusions of the study \"SCHool and outpAtient moNitoring of patients with Cardiac failurE (CHANCE)\", organized by the Society of Experts in Heart Failure.Material and methods  CHANCE was a multicenter randomized study. Patients in the intervention group (IG) received the Structured Education and Flexible Outpatient Control Model, that included telephone contacts plus an additional visit if necessary. The planned visits for the IG and control group (CG) were scheduled at 3, 6, and 12 months. 360 IG patients and 385 CG patients were included in the analysis. In the main analysis of the CHANCE study, the efficacy was assessed by the impact on the hard endpoints (mortality and rehospitalizations), clinical condition, functional capabilities, quality of life, anxiety and depressive symptoms, and cost-effectiveness. Also, a comprehensive assessment was performed of the prevalence, structure, and dynamics of anxiety and depressive symptoms depending on the changes in the clinical condition.Results Mortality significantly differed between the groups: 30 (8.3%) patients died in the IG and 50 (13.0%) in the CG. The relative risk of death was 0.68, 95% confidence interval 0.42-0.99, p = 0.044. To prevent one death, it was necessary to educate and monitor 21 patients with clinically evident chronic heart failure (CHF) according to the principles of the CHANCE program. According to the dynamics of the Clinical Condition Assessment Scale (SCAS), the score difference between the groups was 1.7 (p&lt;0.001) after 12 months of follow-up in favor of the IG group. In 12 months, the increase in the 6-minute walk test distance was 98.7 m in the IG and 42.9 m in the CG (p&lt;0.001). The change from baseline in the Minnesota questionnaire total score was 15.3 ± 16.3 in the IG (p&lt;0.001) and 6.2 ± 15.3 in the CG (p&lt;0.001). The odds of developing depressive symptoms increased with each SCAS point by 19% (p = 0.0002). The odds of developing anxiety symptoms increased with each SCAS point by 12% (p = 0.02). The odds of developing the most unfavorable combination of anxiety and depressive symptoms increased with each SCAS point by 41% (p = 0.000002). The participation of patients in the study increased the odds of reducing the anxiety and depressive symptoms in patients with CHF by 2.35 times (p&lt;0.0001), to a greater extent in women.Conclusion      The CHANCE study that included 42 centers in 23 cities of Russia became the forerunner of the first initiatives in organizing the outpatient follow-up of patients in real clinical practice and serves as a vivid example of the importance of national research programs. Their implementation allows obtaining results that can be scaled up throughout the country to make an important contribution to the improvement of medical care for patients with CHF.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 11","pages":"37-47"},"PeriodicalIF":0.5,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}