Pub Date : 2021-11-26DOI: 10.38109/2225-1685-2021-4-80-86
E. A. Rezukhina, I. Korobkova, N. Danilov, V. Gramovich, T. Martynyuk
Our observation demonstrates a case of a 40-year-old female with idiopathic pulmonary arterial hypertension World Health Organization functional class III, who was admitted to NMRC of Cardiology repeatedly due to disease progression including dyspnea worsening and exercise tolerance decrease after previous COVID-19 infection on riociguat (7.5 mg daily), macitentan (10 mg daily) and selexipag (1600 mcg daily) therapy. Clinical examination demonstrated high-risk status according to the expected 1-year mortality. Due to unreleased treatment goals and high-risk status, we performed transition from selexipag to inhale iloprost. After therapy escalation the patient demonstrated a significant improvement in clinical condition, dyspnea reduction and exercise tolerance increase. The current treatment strategy for pulmonary arterial hypertension is based on regular multiparametric risk stratification approach in PAH patients. The impact of COVID-19 may become an important cause of clinical worsening in PAH patients during COVID-19 pandemic. Directed on vasodilatation and antiproliferation mechanisms of action of PAH-specific drugs are supposed to be protective in COVID-19 patients. However, the probability of clinical worsening in PAH patients despite PAH-specific therapy intake needs to be closely monitored to perform timely treatment correction in order to achieve low-risk status and to improve the prognosis of PAH patients.
我们的观察显示了一例40岁女性特发性肺动脉高压患者，世界卫生组织功能III级，在先前的COVID-19感染后，由于疾病进展，包括呼吸困难恶化和运动耐量下降，多次入住NMRC心脏病学，服用瑞西格特(7.5 mg /天)，马西坦(10 mg /天)和selexipag (1600 mcg /天)治疗。根据1年预期死亡率，临床检查显示为高危状态。由于未公布的治疗目标和高危状态，我们进行了从selexipag到吸入伊洛前列素的过渡。在治疗升级后，患者表现出临床状况的显著改善，呼吸困难减轻，运动耐量增加。目前肺动脉高压的治疗策略是基于PAH患者的常规多参数风险分层方法。COVID-19的影响可能成为COVID-19大流行期间PAH患者临床恶化的重要原因。pah特异性药物对COVID-19患者的血管舒张和抗增殖作用机制可能具有保护作用。然而，需要密切监测PAH患者在接受PAH特异性治疗后临床恶化的概率，及时进行治疗纠正，以达到低风险状态，改善PAH患者的预后。
{"title":"COVID-19 pandemic challenges: on the way to overcome obstacles in realization of PAH-specific therapy treatment goals","authors":"E. A. Rezukhina, I. Korobkova, N. Danilov, V. Gramovich, T. Martynyuk","doi":"10.38109/2225-1685-2021-4-80-86","DOIUrl":"https://doi.org/10.38109/2225-1685-2021-4-80-86","url":null,"abstract":"Our observation demonstrates a case of a 40-year-old female with idiopathic pulmonary arterial hypertension World Health Organization functional class III, who was admitted to NMRC of Cardiology repeatedly due to disease progression including dyspnea worsening and exercise tolerance decrease after previous COVID-19 infection on riociguat (7.5 mg daily), macitentan (10 mg daily) and selexipag (1600 mcg daily) therapy. Clinical examination demonstrated high-risk status according to the expected 1-year mortality. Due to unreleased treatment goals and high-risk status, we performed transition from selexipag to inhale iloprost. After therapy escalation the patient demonstrated a significant improvement in clinical condition, dyspnea reduction and exercise tolerance increase. The current treatment strategy for pulmonary arterial hypertension is based on regular multiparametric risk stratification approach in PAH patients. The impact of COVID-19 may become an important cause of clinical worsening in PAH patients during COVID-19 pandemic. Directed on vasodilatation and antiproliferation mechanisms of action of PAH-specific drugs are supposed to be protective in COVID-19 patients. However, the probability of clinical worsening in PAH patients despite PAH-specific therapy intake needs to be closely monitored to perform timely treatment correction in order to achieve low-risk status and to improve the prognosis of PAH patients.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77557041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.38109/2225-1685-2021-3-14-21
G. Pushkarev, S. Matskeplishvili, V. Kuznetsov, E. Akimova
Purpose: To define total 10-year cardiovascular mortality risk in Russian females in dependence on traditional and psychosocial risk factors (RF) and to design the algorithm of its estimation.Methods. The study included non-organized population of Central Administrative district of Tyumen city. Epidemiological study, based on the representative selection of 1000 females aged 25-64 years. Screening respond was 81.3%. Cardiovascular mortality rate within 10 years was studied. Totally, 31 cases of cardiovascular death were registered in female cohort within 10year follow-up. We used a multivariate Cox regression model to estimate hazard ratio (HR) and confidence interval (CI). Relations between mortality rate and factors such as age, smoking, education, occupation, marital status, systolic and diastolic blood pressure (SBP and DBP), body mass index, total cholesterol, cholesterol of low and high density lipoproteins were analyzed.Results. To build a model of total cardiovascular risk, six statistically significant indicators were selected: age (HR – 1.099, 95% CI 1.032-1.1.69), SBP (1.026, 95% CI 1.011-1.041), primary education (4.315, 95% CI 1.878-9.910), work associated with heavy physical labor (4.073, 95% CI 1.324-12.528), executives (3.822, 95% CI 1.386-10.537) and marital status (2.978, 95% CI 1.197-7.409). Based on these data, model for total cardiovascular mortality risk in females was designed with good predictive accuracy (AUC was 0.882, 95% CI – 0.833 – 0.930).Conclusion. Thus, created mathematical model, built based on statistically significant traditional and psychosocial RF, makes it possible to effectively predict the total cardiovascular risk at the individual level in the female population.
目的:确定俄罗斯女性依赖传统和社会心理危险因素(RF)的10年心血管总死亡风险，并设计其估计算法。研究对象为秋明市中央行政区无组织人口。流行病学研究，基于1000名25-64岁女性的代表性选择。筛查应答率为81.3%。研究10年内心血管疾病死亡率。在随访10年的女性队列中，共登记了31例心血管死亡病例。我们使用多变量Cox回归模型来估计风险比(HR)和置信区间(CI)。分析死亡率与年龄、吸烟、受教育程度、职业、婚姻状况、收缩压和舒张压、体重指数、总胆固醇、低、高密度脂蛋白胆固醇等因素的关系。为了建立总心血管风险模型，我们选择了6个具有统计学意义的指标:年龄(HR - 1.099, 95% CI 1.032-1.1.69)、SBP (1.026, 95% CI 1.011-1.041)、小学教育程度(4.315,95% CI 1.878-9.910)、与重体力劳动相关的工作(4.073,95% CI 1.324-12.528)、高管(3.822,95% CI 1.384 -10.537)和婚姻状况(2.978,95% CI 1.197-7.409)。在此基础上设计的女性心血管总死亡风险模型具有较好的预测精度(AUC为0.882,95% CI为0.833 ~ 0.930)。因此，基于统计上显著的传统和社会心理RF建立的数学模型，可以有效地预测女性人群在个体水平上的心血管总风险。
{"title":"Algorithm for assessing the total 10 years risk of death from cardiovascular diseases in women 25-64 years old in Tyumen (Tyumen risk scale)","authors":"G. Pushkarev, S. Matskeplishvili, V. Kuznetsov, E. Akimova","doi":"10.38109/2225-1685-2021-3-14-21","DOIUrl":"https://doi.org/10.38109/2225-1685-2021-3-14-21","url":null,"abstract":"Purpose: To define total 10-year cardiovascular mortality risk in Russian females in dependence on traditional and psychosocial risk factors (RF) and to design the algorithm of its estimation.Methods. The study included non-organized population of Central Administrative district of Tyumen city. Epidemiological study, based on the representative selection of 1000 females aged 25-64 years. Screening respond was 81.3%. Cardiovascular mortality rate within 10 years was studied. Totally, 31 cases of cardiovascular death were registered in female cohort within 10year follow-up. We used a multivariate Cox regression model to estimate hazard ratio (HR) and confidence interval (CI). Relations between mortality rate and factors such as age, smoking, education, occupation, marital status, systolic and diastolic blood pressure (SBP and DBP), body mass index, total cholesterol, cholesterol of low and high density lipoproteins were analyzed.Results. To build a model of total cardiovascular risk, six statistically significant indicators were selected: age (HR – 1.099, 95% CI 1.032-1.1.69), SBP (1.026, 95% CI 1.011-1.041), primary education (4.315, 95% CI 1.878-9.910), work associated with heavy physical labor (4.073, 95% CI 1.324-12.528), executives (3.822, 95% CI 1.386-10.537) and marital status (2.978, 95% CI 1.197-7.409). Based on these data, model for total cardiovascular mortality risk in females was designed with good predictive accuracy (AUC was 0.882, 95% CI – 0.833 – 0.930).Conclusion. Thus, created mathematical model, built based on statistically significant traditional and psychosocial RF, makes it possible to effectively predict the total cardiovascular risk at the individual level in the female population.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81417599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.38109/2225-1685-2021-3-28-35
E. G. Fedina, K. A. Perova, T. Teptsova, D. S. Shchurov
The study aims to estimate the MitraClip system’s cost-effectiveness compared with optimal medical therapy in adult patients with inoperable mitral regurgitation and assess its impact on the budget of the Russian Federation health system.Materials and methods. The cost-effectiveness analysis of the MitraClip system was carried out using the Markov model. The time horizon was three & five years. The budget impact analysis (BIA) model compared the costs of treating patients distributed across different management practices. Standard management practice included only optimal medical therapy. Expected management practice included different patient allocation between the MitraClip system and optimal medical therapy. The time horizon for the budget impact analysis was five years. Results. The incremental cost-effectiveness ratio (ICER) per additional quality-adjusted life-year (QALY) gained of the MitraClip system in comparison with optimal medical therapy was 6,271,657 rubles in three years and 3,451,342 rubles in five years. Based on the BIA results of the MitraClip system, its use would lead to an increase in costs by 12.6 billion rubles (+6.09%, minimal scenario), by 37.8 billion rubles (+18.28%, optimal scenario) or by 63 billion rubles (+30.47%, maximum scenario).Conclusion. As a result of the analysis performed, it was found that economic efficiency is noted with an increasing time horizon of up to five years. The obtained ICER values are comparable with the average values obtained in other foreign cost-effectiveness studies. The use of this technology will lead to an increase in direct medical costs by 6.09% over five years compared to the current management practice. In more comprehensive MitraClip system implementation (maximum scenario), direct medical costs will increase by 30.47% compared to the current management practice.
{"title":"Cost-effectiveness study of the MitraClip system for mitral regurgitation treatment in inoperable patients","authors":"E. G. Fedina, K. A. Perova, T. Teptsova, D. S. Shchurov","doi":"10.38109/2225-1685-2021-3-28-35","DOIUrl":"https://doi.org/10.38109/2225-1685-2021-3-28-35","url":null,"abstract":"The study aims to estimate the MitraClip system’s cost-effectiveness compared with optimal medical therapy in adult patients with inoperable mitral regurgitation and assess its impact on the budget of the Russian Federation health system.Materials and methods. The cost-effectiveness analysis of the MitraClip system was carried out using the Markov model. The time horizon was three & five years. The budget impact analysis (BIA) model compared the costs of treating patients distributed across different management practices. Standard management practice included only optimal medical therapy. Expected management practice included different patient allocation between the MitraClip system and optimal medical therapy. The time horizon for the budget impact analysis was five years. Results. The incremental cost-effectiveness ratio (ICER) per additional quality-adjusted life-year (QALY) gained of the MitraClip system in comparison with optimal medical therapy was 6,271,657 rubles in three years and 3,451,342 rubles in five years. Based on the BIA results of the MitraClip system, its use would lead to an increase in costs by 12.6 billion rubles (+6.09%, minimal scenario), by 37.8 billion rubles (+18.28%, optimal scenario) or by 63 billion rubles (+30.47%, maximum scenario).Conclusion. As a result of the analysis performed, it was found that economic efficiency is noted with an increasing time horizon of up to five years. The obtained ICER values are comparable with the average values obtained in other foreign cost-effectiveness studies. The use of this technology will lead to an increase in direct medical costs by 6.09% over five years compared to the current management practice. In more comprehensive MitraClip system implementation (maximum scenario), direct medical costs will increase by 30.47% compared to the current management practice.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88129857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.38109/2225-1685-2021-3-22-27
A. Ivaschenko, V. Ezhov, L. V. Yezhova, T. S. Yanovskiy, V. I. Mizin, A. Yarosh, P. Grigoriev, A. F. Pyankov
The aim of this work is to assess the influence of the climatic and weather characteristics of the South Coast of Crimea (SCC) on the effectiveness of health resort medical rehabilitation (MR) of patients with ischemic heart disease (IHD).Materials and methods. A study was carried out in a group of 276 patients with IHD. The influence of climatic and weather characteristics of the SCC were assessed using the methods developed by the «ARI n.a. I.M. Sechenov» - modified clinical index on weather pathogenicity (CIPP-M) and MR assessment according to the criteria of the» International classification of functioning, disabilities and health» (ICF).Results. Regression equations for the dynamics of the ICF b2401, b280, b4301 and b440 domains on the values of air temperature (AT-M), atmospheric pressure variability (APV), air temperature variability (ATV-M) wind speed (WS-M) and total CIPP-M have been developed, which allow to reliably form a rehabilitation prognosis for patients with IHD for all terms of health resort treatment in the SCC.Conclusions. The use of modernized clinical indices of weather pathogenicity allows one to adequately assess and predict the effect of weather dynamics and form a rehabilitation prognosis for patients with IHD.
{"title":"Weather dependence of medical rehabilitation efficiency in patients with ischemic heart disease on the resort of the South Coast of Crimea","authors":"A. Ivaschenko, V. Ezhov, L. V. Yezhova, T. S. Yanovskiy, V. I. Mizin, A. Yarosh, P. Grigoriev, A. F. Pyankov","doi":"10.38109/2225-1685-2021-3-22-27","DOIUrl":"https://doi.org/10.38109/2225-1685-2021-3-22-27","url":null,"abstract":"The aim of this work is to assess the influence of the climatic and weather characteristics of the South Coast of Crimea (SCC) on the effectiveness of health resort medical rehabilitation (MR) of patients with ischemic heart disease (IHD).Materials and methods. A study was carried out in a group of 276 patients with IHD. The influence of climatic and weather characteristics of the SCC were assessed using the methods developed by the «ARI n.a. I.M. Sechenov» - modified clinical index on weather pathogenicity (CIPP-M) and MR assessment according to the criteria of the» International classification of functioning, disabilities and health» (ICF).Results. Regression equations for the dynamics of the ICF b2401, b280, b4301 and b440 domains on the values of air temperature (AT-M), atmospheric pressure variability (APV), air temperature variability (ATV-M) wind speed (WS-M) and total CIPP-M have been developed, which allow to reliably form a rehabilitation prognosis for patients with IHD for all terms of health resort treatment in the SCC.Conclusions. The use of modernized clinical indices of weather pathogenicity allows one to adequately assess and predict the effect of weather dynamics and form a rehabilitation prognosis for patients with IHD.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75855875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.38109/2225-1685-2021-3-6-12
L. Afandieva
Aim. Study of the dependence of mortality from CVD on helio-seismic indicators in the Shamakhi region of the Republic of Azerbaijan.Materials and methods. 352 case histories of patients who died in 2013 from various diseases were reviewed. The relationship was established between the number of deaths, their causes, distribution by sex and age with the magnitude of earthquakes, the depth of the epicenter and seismological activity by months. The data obtained were statistically processed using the Statistica 12.0 for Windows software package (Statsoft Inc., USA). To establish correlations, Pearson Chi-Square Tests was calculated, the results were considered reliable at p <0.05.Results. Statistically significant (p <0.001) more deaths were observed at the age of 80-89 years in men, and at the age of 70-79 years in women. Also, the relationship between mortality and the depth of the seismic process and the magnitude of the earthquake was established, in particular, the greatest number of deaths was observed at a depth of the seismic process <10 km and with a magnitude of 1.1-2.0 ml. In all months, the number of deaths was higher with a magnitude of 1.1-2.0 Ml. Statistically significant (p <0.005) was the fact that the nosology of the studied diseases was dependent on the age of the patients. Thus, a greater number of deaths in all age groups accounted for heart failure. A statistically significant (p <0.005) dependence of the depth of the seismic process on the month of death of patients was established, in particular, for all months, deaths coincided with the depth of the process less than 10 km. At the age of 40-70 years, a significantly greater number of deaths were from heart failure in men, and from 70 years and above in women.Conclusion. Thus, there is a close correlation between geomagnetic changes and mortality from CVD, which is realized in the form of an increase in the frequency of cases and deaths, and the number of these cases increases with the age of patients and changes in the magnitude and depth of the earthquake.
{"title":"The influence of geomagnetic and seismic parameters on mortality from cardiovascular pathologies in the Shamakhi Region of the Republic of Azerbaijan","authors":"L. Afandieva","doi":"10.38109/2225-1685-2021-3-6-12","DOIUrl":"https://doi.org/10.38109/2225-1685-2021-3-6-12","url":null,"abstract":"Aim. Study of the dependence of mortality from CVD on helio-seismic indicators in the Shamakhi region of the Republic of Azerbaijan.Materials and methods. 352 case histories of patients who died in 2013 from various diseases were reviewed. The relationship was established between the number of deaths, their causes, distribution by sex and age with the magnitude of earthquakes, the depth of the epicenter and seismological activity by months. The data obtained were statistically processed using the Statistica 12.0 for Windows software package (Statsoft Inc., USA). To establish correlations, Pearson Chi-Square Tests was calculated, the results were considered reliable at p <0.05.Results. Statistically significant (p <0.001) more deaths were observed at the age of 80-89 years in men, and at the age of 70-79 years in women. Also, the relationship between mortality and the depth of the seismic process and the magnitude of the earthquake was established, in particular, the greatest number of deaths was observed at a depth of the seismic process <10 km and with a magnitude of 1.1-2.0 ml. In all months, the number of deaths was higher with a magnitude of 1.1-2.0 Ml. Statistically significant (p <0.005) was the fact that the nosology of the studied diseases was dependent on the age of the patients. Thus, a greater number of deaths in all age groups accounted for heart failure. A statistically significant (p <0.005) dependence of the depth of the seismic process on the month of death of patients was established, in particular, for all months, deaths coincided with the depth of the process less than 10 km. At the age of 40-70 years, a significantly greater number of deaths were from heart failure in men, and from 70 years and above in women.Conclusion. Thus, there is a close correlation between geomagnetic changes and mortality from CVD, which is realized in the form of an increase in the frequency of cases and deaths, and the number of these cases increases with the age of patients and changes in the magnitude and depth of the earthquake.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82614630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.38109/2225-1685-2021-3-54-93
Y. Karpov, O. Barbarash, A. A. Boschenko, V. Kashtalap, V. Kukharchuk, V. Mironov, E. Panchenko, M. M. Ruda, A. Samko, G. N. Soboleva, A. Shiryaev
Disclaimer The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.Members of the Working Group confirmed the lack of financial support / conflict of interest. In the event of a conflict of interest being reported, the member (s) of the Working Group was (were) excluded from the discussion of sections related to the area of conflict of interest.
{"title":"Eurasian Guidelines for the diagnostics and management of stable coronary artery disease (2020-2021)","authors":"Y. Karpov, O. Barbarash, A. A. Boschenko, V. Kashtalap, V. Kukharchuk, V. Mironov, E. Panchenko, M. M. Ruda, A. Samko, G. N. Soboleva, A. Shiryaev","doi":"10.38109/2225-1685-2021-3-54-93","DOIUrl":"https://doi.org/10.38109/2225-1685-2021-3-54-93","url":null,"abstract":"Disclaimer The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.Members of the Working Group confirmed the lack of financial support / conflict of interest. In the event of a conflict of interest being reported, the member (s) of the Working Group was (were) excluded from the discussion of sections related to the area of conflict of interest.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81902050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.38109/2225-1685-2021-3-36-45
Z. Kobalava, E. Kolesnik
Observational and interventional studies have shown that intensive blood pressure control may benefit in patients with diabetes. The Action in Diabetes and Vascular Disease: Preterax and Diarnicron MR Controlled Evaluation (ADVANCE) international randomized, controlled, clinical trial was launched in 2001. According to the results of the study, the risk of major micro- and macrovascular events (primary endpoint) significantly decreased by 9%, while the risks of cardiovascular death and death from any cause decreased by 18% and 14%, respectively. There was a decrease in the risks of microvascular complications – any renal event, the appearance or worsening of nephropathy and the appearance of microalbuminuria by 21%, 18% and 21%, respectively. The results of the antihypertensive part of the ADVANCE study supplemented the expanding evidence base and served as the basis for changing clinical guidelines for the management of patients with hypertension and diabetes. According to the updated joint guidelines of the European Society of Cardiology / European Association for the Study of Diabetes (ESC/EASD), the target systolic / diastolic blood pressure levels should be 130/80 mmHg, with some exceptions, and the fixed combination of the RAAS blocker with a diuretic or calcium antagonist is suggested as first-line therapy.The observational ADVANCE-ON study, which enrolled 8494 patients out of 11 140 patients randomized to the ADVANCE study, found a memory effect, or ‘inheritance’, in which intensive blood pressure control during the study had a beneficial effect on various outcomes after its termination. These findings highlight the importance of achieving and maintaining optimal blood pressure control to reduce the risk of micro- and macrovascular complications.
{"title":"ADVANCE research 20 years later","authors":"Z. Kobalava, E. Kolesnik","doi":"10.38109/2225-1685-2021-3-36-45","DOIUrl":"https://doi.org/10.38109/2225-1685-2021-3-36-45","url":null,"abstract":"Observational and interventional studies have shown that intensive blood pressure control may benefit in patients with diabetes. The Action in Diabetes and Vascular Disease: Preterax and Diarnicron MR Controlled Evaluation (ADVANCE) international randomized, controlled, clinical trial was launched in 2001. According to the results of the study, the risk of major micro- and macrovascular events (primary endpoint) significantly decreased by 9%, while the risks of cardiovascular death and death from any cause decreased by 18% and 14%, respectively. There was a decrease in the risks of microvascular complications – any renal event, the appearance or worsening of nephropathy and the appearance of microalbuminuria by 21%, 18% and 21%, respectively. The results of the antihypertensive part of the ADVANCE study supplemented the expanding evidence base and served as the basis for changing clinical guidelines for the management of patients with hypertension and diabetes. According to the updated joint guidelines of the European Society of Cardiology / European Association for the Study of Diabetes (ESC/EASD), the target systolic / diastolic blood pressure levels should be 130/80 mmHg, with some exceptions, and the fixed combination of the RAAS blocker with a diuretic or calcium antagonist is suggested as first-line therapy.The observational ADVANCE-ON study, which enrolled 8494 patients out of 11 140 patients randomized to the ADVANCE study, found a memory effect, or ‘inheritance’, in which intensive blood pressure control during the study had a beneficial effect on various outcomes after its termination. These findings highlight the importance of achieving and maintaining optimal blood pressure control to reduce the risk of micro- and macrovascular complications.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76232919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.38109/2225-1685-2021-3-46-53
O. Rotar
The paper presents the overview evolution of hypertension identification and treatment during last 15 years after publication of ASCOT trial (AngloScandinavian Cardiac Outcomes Trial) results. It discusses possible mechanism of more significant cardiovascular risk reduction in amlodipine/ perindopril group comparing with atenolol/diuretic group: central blood pressure, arterial stiffness, asleep blood pressure and BP variability. Innovative approaches in time of ASCOТ trial such as combined antihypertensive therapy from start and RAAS inhibitor as first line now became routine practice in actual guidelines. Importance of early prescribing of fixed antihypertensive combination and choice of safe drugs help to improve adherence and decrease resistant hypertension prevalence. Prevention of new onset of diabetes in metabolic patients needs application of metabolically neutral drugs and including of renin-angiotensin-aldosterone inhibitors in combination therapy. Results of ASCOT-Legacy trial demonstrated long-term protective effect of amlodipine/perindopril combination resulting in decreasing mortality, rate of stroke and coronary events during 20-years follow-up.
{"title":"Evidence born from ASCOT trial – still important after 15 years","authors":"O. Rotar","doi":"10.38109/2225-1685-2021-3-46-53","DOIUrl":"https://doi.org/10.38109/2225-1685-2021-3-46-53","url":null,"abstract":"The paper presents the overview evolution of hypertension identification and treatment during last 15 years after publication of ASCOT trial (AngloScandinavian Cardiac Outcomes Trial) results. It discusses possible mechanism of more significant cardiovascular risk reduction in amlodipine/ perindopril group comparing with atenolol/diuretic group: central blood pressure, arterial stiffness, asleep blood pressure and BP variability. Innovative approaches in time of ASCOТ trial such as combined antihypertensive therapy from start and RAAS inhibitor as first line now became routine practice in actual guidelines. Importance of early prescribing of fixed antihypertensive combination and choice of safe drugs help to improve adherence and decrease resistant hypertension prevalence. Prevention of new onset of diabetes in metabolic patients needs application of metabolically neutral drugs and including of renin-angiotensin-aldosterone inhibitors in combination therapy. Results of ASCOT-Legacy trial demonstrated long-term protective effect of amlodipine/perindopril combination resulting in decreasing mortality, rate of stroke and coronary events during 20-years follow-up.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81066401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-29DOI: 10.38109/2225-1685-2021-2-92-102
S. R. Gilyarevskij, N. G. Bendeliani, M. V. Golshmid, Irina M. Kuz’mina, I. Andreeva
Сведения об авторах: *Автор ответственный за переписку: Гиляревский Сергей Руджерович, д.м.н., профессор, профессор группы по разработке и реализации профильных образовательных программ отдела организационно-методического управления и анализа качества медицинской помощи ФГБУ «НМИЦ ТПМ» Минздрава России, профессор кафедры клинической фармакологии и терапии РМАНПО, тел. +7(495)945-70-90, sgilarevsky@rambler.ru, 125993, г. Москва, ул. Баррикадная, д. 2/1, стр. 1, ORCID: 0000-0002-8505-1848. Бенделиани Нана Георгиевна, д.м.н., старший научный сотрудник научно-консультативного отделения института коронарной и сосудистой хирургии (ИКиСХ) консультативно-диагностического центра (КДЦ) ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии имени А.Н. Бакулева» Министерство здравоохранения РФФГБУ «НМИЦССХ им. А.Н. Бакулева» Минздрава России, n.bendo@mail.ru, ORCID: 0000-00033102-1958. Голшмид Мария Владимировна, к.м.н., доцент кафедры клинической фармакологии и терапии РМАНПО, golshmid@yandex.ru, ORCID: 0000-0002-98654998. Кузьмина Ирина Михайловна, к.м.н., заведующий научным отделением неотложной кардиологии ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ». ORCID: 0000-0001-9458-7305. kuzmina.sklif@gmail.com Андреева Ирина Геннадьевна, д.м.н., профессор кафедры педагогики и психологии Московского социально-педагогического института, andreevaira@mail.ru ПРИМЕНЕНИЕ КОМБИНИРОВАННЫХ ПРЕПАРАТОВ С ПОСТОЯННЫМИ ДОЗАМИ АНТИГИПЕРТЕНЗИВНЫХ СРЕДСТВ КАК НАЧАЛЬНАЯ ТАКТИКА ЛЕЧЕНИЯ ПРИ ПОВЫШЕННОМ УРОВНЕ АРТЕРИАЛЬНОГО ДАВЛЕНИЯ: ДОКАЗАННЫЕ ФАКТЫ И МНЕНИЕ ЭКСПЕРТОВ
{"title":"THE APPLICATION OF COMBINED PREPARATIONS WITH CONSTANT DOSES OF ANTIHYPERTENSIVE DRUGS AS THE INITIAL TACTICS OF TREATMENT AT HIGH BLOOD PRESSURE LEVEL: PROVEN FACTS AND EXPERT’S OPINION","authors":"S. R. Gilyarevskij, N. G. Bendeliani, M. V. Golshmid, Irina M. Kuz’mina, I. Andreeva","doi":"10.38109/2225-1685-2021-2-92-102","DOIUrl":"https://doi.org/10.38109/2225-1685-2021-2-92-102","url":null,"abstract":"Сведения об авторах: *Автор ответственный за переписку: Гиляревский Сергей Руджерович, д.м.н., профессор, профессор группы по разработке и реализации профильных образовательных программ отдела организационно-методического управления и анализа качества медицинской помощи ФГБУ «НМИЦ ТПМ» Минздрава России, профессор кафедры клинической фармакологии и терапии РМАНПО, тел. +7(495)945-70-90, sgilarevsky@rambler.ru, 125993, г. Москва, ул. Баррикадная, д. 2/1, стр. 1, ORCID: 0000-0002-8505-1848. Бенделиани Нана Георгиевна, д.м.н., старший научный сотрудник научно-консультативного отделения института коронарной и сосудистой хирургии (ИКиСХ) консультативно-диагностического центра (КДЦ) ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии имени А.Н. Бакулева» Министерство здравоохранения РФФГБУ «НМИЦССХ им. А.Н. Бакулева» Минздрава России, n.bendo@mail.ru, ORCID: 0000-00033102-1958. Голшмид Мария Владимировна, к.м.н., доцент кафедры клинической фармакологии и терапии РМАНПО, golshmid@yandex.ru, ORCID: 0000-0002-98654998. Кузьмина Ирина Михайловна, к.м.н., заведующий научным отделением неотложной кардиологии ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ». ORCID: 0000-0001-9458-7305. kuzmina.sklif@gmail.com Андреева Ирина Геннадьевна, д.м.н., профессор кафедры педагогики и психологии Московского социально-педагогического института, andreevaira@mail.ru ПРИМЕНЕНИЕ КОМБИНИРОВАННЫХ ПРЕПАРАТОВ С ПОСТОЯННЫМИ ДОЗАМИ АНТИГИПЕРТЕНЗИВНЫХ СРЕДСТВ КАК НАЧАЛЬНАЯ ТАКТИКА ЛЕЧЕНИЯ ПРИ ПОВЫШЕННОМ УРОВНЕ АРТЕРИАЛЬНОГО ДАВЛЕНИЯ: ДОКАЗАННЫЕ ФАКТЫ И МНЕНИЕ ЭКСПЕРТОВ","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81553010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-29DOI: 10.38109/2225-1685-2021-2-84-91
E. Filippov
За последние несколько десятилетий произошли значимые изменения в подходах к ведению пациентов с легочной артериальной гипертензией (ЛАГ). С того момента, когда впервые была обнародована классификация этого заболевания появились новые диагностические возможности и новые препараты, которые позволили улучшить качество жизни и выживаемость пациентов. Статья посвящена вопросам быстрой диагностики ЛАГ в случае ее высокой вероятности. Особое внимание уделено быстрому направлению таких пациентов в экспертный центр, где есть возможность проведения катетеризации правых отделов сердца. Также отмечается важность стратификации риска пациентов, что позволяет уже на раннем этапе назначать комбинированную специфическую терапию, способную значительно улучшать качество жизни и снижать риск развития неблагоприятных исходов. Оценка риска показана всем пациентам как на региональном, так и на экспертном уровне с помощью определения риска 1-летней смертности при ЛАГ. В статье также обсуждаются вопросы диспансерного наблюдения таких пациентов и титрации дозы при назначении специфической терапии экспертным центром. Даны рекомендации по неспецифической терапии ЛАГ, использованиию кислородной поддержки, антикоагулянтов и других препаратов. Особо отмечается, что ингибиторы АПФ, блокаторы рецепторов ангиотензина, бета-блокаторы и ивабрадин, как правило, для лечения ЛАГ не используются, и их применение может ограничить возможности специфической терапии. Иногда пациентам с ЛГ на региональном уровне необходима титрация дозы ЛАГ-специфической терапии, а также регулярное наблюдение, что требует специальных знаний. Это диктует необходимость создания в каждом регионе кабинетов легочной гипертензии или ведения этой группы пациентов в кабинетах высокого риска, где медицинские работники будут иметь необходимые знания и будут регулярно проходить обучение в экспертных центрах. Описанный клинический случай демонстрирует эффективность комбинированной терапии легочной артериальной гипертензии с применением инновационного селективного агониста простациклиновых рецепторов для перорального приема – селексипага. Даны практические рекомендации по титрации дозы и его использованию у пациентов с ЛАГ.
{"title":"PULMONARY ARTERIAL HYPERTENSION: REGIONAL HEALTH CARE OPPORTUNITIES","authors":"E. Filippov","doi":"10.38109/2225-1685-2021-2-84-91","DOIUrl":"https://doi.org/10.38109/2225-1685-2021-2-84-91","url":null,"abstract":"За последние несколько десятилетий произошли значимые изменения в подходах к ведению пациентов с легочной артериальной гипертензией (ЛАГ). С того момента, когда впервые была обнародована классификация этого заболевания появились новые диагностические возможности и новые препараты, которые позволили улучшить качество жизни и выживаемость пациентов. Статья посвящена вопросам быстрой диагностики ЛАГ в случае ее высокой вероятности. Особое внимание уделено быстрому направлению таких пациентов в экспертный центр, где есть возможность проведения катетеризации правых отделов сердца. Также отмечается важность стратификации риска пациентов, что позволяет уже на раннем этапе назначать комбинированную специфическую терапию, способную значительно улучшать качество жизни и снижать риск развития неблагоприятных исходов. Оценка риска показана всем пациентам как на региональном, так и на экспертном уровне с помощью определения риска 1-летней смертности при ЛАГ. В статье также обсуждаются вопросы диспансерного наблюдения таких пациентов и титрации дозы при назначении специфической терапии экспертным центром. Даны рекомендации по неспецифической терапии ЛАГ, использованиию кислородной поддержки, антикоагулянтов и других препаратов. Особо отмечается, что ингибиторы АПФ, блокаторы рецепторов ангиотензина, бета-блокаторы и ивабрадин, как правило, для лечения ЛАГ не используются, и их применение может ограничить возможности специфической терапии. Иногда пациентам с ЛГ на региональном уровне необходима титрация дозы ЛАГ-специфической терапии, а также регулярное наблюдение, что требует специальных знаний. Это диктует необходимость создания в каждом регионе кабинетов легочной гипертензии или ведения этой группы пациентов в кабинетах высокого риска, где медицинские работники будут иметь необходимые знания и будут регулярно проходить обучение в экспертных центрах. Описанный клинический случай демонстрирует эффективность комбинированной терапии легочной артериальной гипертензии с применением инновационного селективного агониста простациклиновых рецепторов для перорального приема – селексипага. Даны практические рекомендации по титрации дозы и его использованию у пациентов с ЛАГ.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90957462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：