Pub Date : 2022-06-20DOI: 10.3897/bgcardio.28.e82414
P. Simeonov, B. Barzashka, D. Trendafilova, J. Jorgova, D. Petkov, P. Abedinov
In recent years the trend towards surgical bioprosthetic valve implantation, especially among young patients, has increased in order to avoid anticoagulant therapy. The patient’s age remains one of the leading risk factors for valve dysfunction. Gold standard for treating such diseases was surgical reintervention until the development of transcatheter heart valves. By 2050 the annual number of patients undergoing surgical bioprosthetic valve implantation is expected to triple from an average of 290,000 in 2003 to over 850,000. This study presents the literature review of Valve in Valve and Valve in Ring procedures, as well as our experience in ViV and ViR transcatheter valve implantation.
{"title":"Valve in valve and valve in ring transcatheter aortic valveimplantation","authors":"P. Simeonov, B. Barzashka, D. Trendafilova, J. Jorgova, D. Petkov, P. Abedinov","doi":"10.3897/bgcardio.28.e82414","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e82414","url":null,"abstract":"In recent years the trend towards surgical bioprosthetic valve implantation, especially among young patients, has increased in order to avoid anticoagulant therapy. The patient’s age remains one of the leading risk factors for valve dysfunction. Gold standard for treating such diseases was surgical reintervention until the development of transcatheter heart valves. By 2050 the annual number of patients undergoing surgical bioprosthetic valve implantation is expected to triple from an average of 290,000 in 2003 to over 850,000. This study presents the literature review of Valve in Valve and Valve in Ring procedures, as well as our experience in ViV and ViR transcatheter valve implantation.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47897470","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 : 2022-06-20DOI: 10.3897/bgcardio.28.e82855
D. Trendafilova, J. Djorgova, H. Varnaliyska, N. Naidenova, R. Stoycheva, R. Valchev, H. Angelov
Introduction: Hemodynamically signifi cant mitral regurgitation (MR) occurs in up to 20-30% of patients with high-grade aortic stenosis (AC) indicated for transcatheter aortic valve implantation (TAVI). Despite the establishment of the method as a standard in the treatment of high-risk patients for surgery worldwide and the growing number of patients treated interventionally, behavior in concomitant signifi cant MR continues to be a diagnostic and therapeutic challenge. The decision to intervene on multiple valves must take into account the additional surgical risk of the combined procedures. Signifi cant MR is associated with a worse prognosis in both surgical and interventional treatment. With high operative risk and signifi cant MR, TAVI is a possible solution due to the proven reduction in severity in a signifi cant proportion of patients. The aim of this paper is to evaluate the impact of signifi cant secondary MR on mortality and rate change after TAVI. Material and methods: The article is a retrospective analysis of 50 patients with high-grade symptomatic aortic stenosis who underwent successful TAVI. Patients were followed for a period of 1 year and were divided into two major groups – no signifi cant MR (0.1 degree) and those with signifi cant secondary MR (≥ grade 2). Overall mortality, cardiovascular mortality, functional class of heart failure according to the NYHA classifi cation, ejection fraction and need for rehospitalizations weremonitored. Conclusions: Hemodynamically signifi cant secondary MR, concomitant high-grade AC before TAVI undergoes positive dynamics in a signifi cant proportion of patients postprocedurally and should be considered when deciding on a therapeutic strategy by the Heart team. The worsening of signifi cant secondary MI in the studied patients is associated with 30-day and one-year cardiovascular mortality and the need for rehospitalization, which is consistent with data that the prognosis is important not only the presence of signifi cant secondary MR, but its dynamics after TAVI.
{"title":"Clinical significance and change in the degree of mitral insufficiency after TAVI","authors":"D. Trendafilova, J. Djorgova, H. Varnaliyska, N. Naidenova, R. Stoycheva, R. Valchev, H. Angelov","doi":"10.3897/bgcardio.28.e82855","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e82855","url":null,"abstract":"Introduction: Hemodynamically signifi cant mitral regurgitation (MR) occurs in up to 20-30% of patients with high-grade aortic stenosis (AC) indicated for transcatheter aortic valve implantation (TAVI). Despite the establishment of the method as a standard in the treatment of high-risk patients for surgery worldwide and the growing number of patients treated interventionally, behavior in concomitant signifi cant MR continues to be a diagnostic and therapeutic challenge. The decision to intervene on multiple valves must take into account the additional surgical risk of the combined procedures. Signifi cant MR is associated with a worse prognosis in both surgical and interventional treatment. With high operative risk and signifi cant MR, TAVI is a possible solution due to the proven reduction in severity in a signifi cant proportion of patients. The aim of this paper is to evaluate the impact of signifi cant secondary MR on mortality and rate change after TAVI. Material and methods: The article is a retrospective analysis of 50 patients with high-grade symptomatic aortic stenosis who underwent successful TAVI. Patients were followed for a period of 1 year and were divided into two major groups – no signifi cant MR (0.1 degree) and those with signifi cant secondary MR (≥ grade 2). Overall mortality, cardiovascular mortality, functional class of heart failure according to the NYHA classifi cation, ejection fraction and need for rehospitalizations weremonitored. Conclusions: Hemodynamically signifi cant secondary MR, concomitant high-grade AC before TAVI undergoes positive dynamics in a signifi cant proportion of patients postprocedurally and should be considered when deciding on a therapeutic strategy by the Heart team. The worsening of signifi cant secondary MI in the studied patients is associated with 30-day and one-year cardiovascular mortality and the need for rehospitalization, which is consistent with data that the prognosis is important not only the presence of signifi cant secondary MR, but its dynamics after TAVI.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45929847","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 : 2022-05-31DOI: 10.18087/cardio.2022.5.n2083
V. Mareev, Y. L. Begrambekova, Y. Mareev, Z. Kobalava, L. Karapetyan, S. Galochkin, E. R. Kazakhmedov, A. Lapshin, A. A. Garganeeva, E. A. Kuzheleva, A. Efremushkina, E. Kiseleva, O. Barbarash, T. Pecherina, A. Galyavich, Z. Galeeva, L. Baleeva, N. Koziolova, A. Veklich, D. Duplyakov, M. N. Maksimova, S. Yakushin, E. Smirnova, E. Sedykh, I. Shaposhnik, N. Makarova, A. A. Zemlyanukhina, V. Skibitsky, A. Fendrikova, A. V. Skibitsky, N. Spiropulos, E. Seredenina, Y. Orlova, K. Eruslanova, Y. Kotovskaya, O. Tkacheva, M. Fedin
Aim To evaluate the prevalence of iron deficiency (ID) in Russian patients with heart failure (HF).Material and methods Iron metabolism variables were studied in 498 (198 women, 300 men) patients with HF. Data were evaluated at admission for HF (97 %) or during an outpatient visit (3 %). ID was determined according to the European Society of Cardiology Guidelines.Results 83.1 % of patients had ID; only 43.5 % of patients with ID had anemia. Patients with ID were older: 70.0 [63.0;79.0] vs. 66.0 years [57.0;75.2] (p=0.009). The number of patients with ID increased in parallel with the increase in HF functional class (FC). Among patients with ID, fewer people were past or current alcohol users (p=0.002), and a greater number of patients had atrial fibrillation (60.1 vs. 45.2 %, p=0.016). A multiple logistic regression showed that more severe HF (HF FC) was associated with a higher incidence of ID detection, whereas past alcohol use was associated with less pronounced ID. An increase in N-terminal pro-brain natriuretic peptide (NT-proBNP) by 100 pg/ml was associated with an increased likelihood of ID (odds ratio, 1.006, 95 % confidence interval: 1.002-1.011, p=0.0152).Conclusion The incidence rate of HF patients is high in the Russian Federation (83.1 %). Only 43.5 % of these patients had anemia. The prevalence of ID in the study population increased with increases in HF FC and NT-proBNP.
{"title":"[Iron deficiency in Russia heart failure patients. Observational cross-sectional multicenter study].","authors":"V. Mareev, Y. L. Begrambekova, Y. Mareev, Z. Kobalava, L. Karapetyan, S. Galochkin, E. R. Kazakhmedov, A. Lapshin, A. A. Garganeeva, E. A. Kuzheleva, A. Efremushkina, E. Kiseleva, O. Barbarash, T. Pecherina, A. Galyavich, Z. Galeeva, L. Baleeva, N. Koziolova, A. Veklich, D. Duplyakov, M. N. Maksimova, S. Yakushin, E. Smirnova, E. Sedykh, I. Shaposhnik, N. Makarova, A. A. Zemlyanukhina, V. Skibitsky, A. Fendrikova, A. V. Skibitsky, N. Spiropulos, E. Seredenina, Y. Orlova, K. Eruslanova, Y. Kotovskaya, O. Tkacheva, M. Fedin","doi":"10.18087/cardio.2022.5.n2083","DOIUrl":"https://doi.org/10.18087/cardio.2022.5.n2083","url":null,"abstract":"Aim To evaluate the prevalence of iron deficiency (ID) in Russian patients with heart failure (HF).Material and methods Iron metabolism variables were studied in 498 (198 women, 300 men) patients with HF. Data were evaluated at admission for HF (97 %) or during an outpatient visit (3 %). ID was determined according to the European Society of Cardiology Guidelines.Results 83.1 % of patients had ID; only 43.5 % of patients with ID had anemia. Patients with ID were older: 70.0 [63.0;79.0] vs. 66.0 years [57.0;75.2] (p=0.009). The number of patients with ID increased in parallel with the increase in HF functional class (FC). Among patients with ID, fewer people were past or current alcohol users (p=0.002), and a greater number of patients had atrial fibrillation (60.1 vs. 45.2 %, p=0.016). A multiple logistic regression showed that more severe HF (HF FC) was associated with a higher incidence of ID detection, whereas past alcohol use was associated with less pronounced ID. An increase in N-terminal pro-brain natriuretic peptide (NT-proBNP) by 100 pg/ml was associated with an increased likelihood of ID (odds ratio, 1.006, 95 % confidence interval: 1.002-1.011, p=0.0152).Conclusion The incidence rate of HF patients is high in the Russian Federation (83.1 %). Only 43.5 % of these patients had anemia. The prevalence of ID in the study population increased with increases in HF FC and NT-proBNP.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"41 1","pages":"4-8"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82483279","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 : 2022-05-31DOI: 10.18087/cardio.2022.5.n2022
O. Drapkina, Y. L. Begrambekova, D. O. Orlov, R. Shepel, T. V. Samojlov
Aim To evaluate clinical practice of primary care physicians with respect of preventing behavioral risk factors in patients as well as objective and subjective factors that influence their motivation for taking preventive measures. Material and methods This study was a cross-sectional survey. The questionnaire was anonymous and included closed questions and multiple-choice questions. Based on the obtained results, prevalence of modifiable risk factors for chronic noninfectious diseases (CNID) was comprehensively evaluated in the survey population. Also, a special quantitative variable was introduced, the Index of Behavioral Risk Factors. that reflected the burden of risk factors. This composite index included the degree of risk factor in a specific respondent, for example, obesity degree, number of cigarettes smoked per day, severity of hypodynamia. Physicians' knowledge and beliefs about the effect of physical activity (PA) on certain diseases were evaluated. Result 623 physicians (mean age 40 years (31-52), 85.5 % women) participated in the survey. The respondents included general practitioners (7.5%), cardiologists (2.9 %), preventive care physicians (4.8 %), internists (25.4 %), and other specialists (59.4 %). 70.8 % of respondents never smoked, 17.5 % were current smokers. 38.5% (240) of the surveyed had a normal body weight index (BWI); 41.7 % (260) were overweight; 11.6 % (72) had degree 1 obesity; 3.7 % (23) had degree 2 obesity; and 0.8 % had degree 3 obesity. A very low PA level was noticed; most of the surveyed exercised not more than once a week (median, 1 (0-3) time). More than 90 % had behavioral risk factors, low PA and excessive body weight. The physicians with a higher index of behavioral risk factors 50% less frequently checked the body weight of patients (odds ratio (OR), 0.541; 95 % confidence interval (CI): 0.388-0.753, p<0.05); 33% less frequently asked whether the patient smoked (OR, 0.675; 95 % CI: 0.465-0.978, p=0.037); 50% less frequently asked the patients about his/her level of PA (OR, 0.482; 95 % CI: 0.343-0.678, p<0.001); and 60% less frequently recommended increasing the PA (OR, 0.408; 95 % CI: 0.292-0.570, p<0.001).Conclusion Most of the surveyed were aware of the benefits of PA for prevention and treatment of CNID, however, they related the mechanism of this effect only with weight loss. The most frequently mentioned barriers to behavioral risk counseling were uncertainty about whether such counseling was within the physician's professional competence, lack of time, lack of confidence in the provision of advice and the effectiveness of interventions, and lack of patients' compliance.
{"title":"[Determination of factors influencing the desire and possibilities of prevention of inactivity and other behavi-oral risk factors by primary care physicians (REFLECTION). The results of a one-time survey].","authors":"O. Drapkina, Y. L. Begrambekova, D. O. Orlov, R. Shepel, T. V. Samojlov","doi":"10.18087/cardio.2022.5.n2022","DOIUrl":"https://doi.org/10.18087/cardio.2022.5.n2022","url":null,"abstract":"Aim To evaluate clinical practice of primary care physicians with respect of preventing behavioral risk factors in patients as well as objective and subjective factors that influence their motivation for taking preventive measures. Material and methods This study was a cross-sectional survey. The questionnaire was anonymous and included closed questions and multiple-choice questions. Based on the obtained results, prevalence of modifiable risk factors for chronic noninfectious diseases (CNID) was comprehensively evaluated in the survey population. Also, a special quantitative variable was introduced, the Index of Behavioral Risk Factors. that reflected the burden of risk factors. This composite index included the degree of risk factor in a specific respondent, for example, obesity degree, number of cigarettes smoked per day, severity of hypodynamia. Physicians' knowledge and beliefs about the effect of physical activity (PA) on certain diseases were evaluated. Result 623 physicians (mean age 40 years (31-52), 85.5 % women) participated in the survey. The respondents included general practitioners (7.5%), cardiologists (2.9 %), preventive care physicians (4.8 %), internists (25.4 %), and other specialists (59.4 %). 70.8 % of respondents never smoked, 17.5 % were current smokers. 38.5% (240) of the surveyed had a normal body weight index (BWI); 41.7 % (260) were overweight; 11.6 % (72) had degree 1 obesity; 3.7 % (23) had degree 2 obesity; and 0.8 % had degree 3 obesity. A very low PA level was noticed; most of the surveyed exercised not more than once a week (median, 1 (0-3) time). More than 90 % had behavioral risk factors, low PA and excessive body weight. The physicians with a higher index of behavioral risk factors 50% less frequently checked the body weight of patients (odds ratio (OR), 0.541; 95 % confidence interval (CI): 0.388-0.753, p<0.05); 33% less frequently asked whether the patient smoked (OR, 0.675; 95 % CI: 0.465-0.978, p=0.037); 50% less frequently asked the patients about his/her level of PA (OR, 0.482; 95 % CI: 0.343-0.678, p<0.001); and 60% less frequently recommended increasing the PA (OR, 0.408; 95 % CI: 0.292-0.570, p<0.001).Conclusion Most of the surveyed were aware of the benefits of PA for prevention and treatment of CNID, however, they related the mechanism of this effect only with weight loss. The most frequently mentioned barriers to behavioral risk counseling were uncertainty about whether such counseling was within the physician's professional competence, lack of time, lack of confidence in the provision of advice and the effectiveness of interventions, and lack of patients' compliance.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"42 1","pages":"9-17"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84844043","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 : 2022-05-31DOI: 10.18087/cardio.2022.5.n1945
N. Pogosova, S. Isakova, O. Sokolova, A. Ausheva, R. Zhetisheva, A. Arutyunov
Aim To study factors that influence the consistency of real prescriptions with applicable national guidelines for outpatient physicians in the management of patients with common cardiovascular diseases (CVDs).Material and methods This was a cross-sectional study based on 16 randomly selected municipal polyclinics, where internists filled in validated questionnaires, including the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), Hospital Anxiety and Depression Scale (HADS), Visual Analogue Scale (VAS), WHO Quality of Life - BREF (WHOQOL-BREF), and the Personal Decision-Making Factors (PDF-25). Participating physicians provided outpatient case reports of sequentially arriving patients with a high risk of CVD or confirmed CVDs during 2-3 working days, corresponding to the questionnaire period of ±1 week. The consistency of the prescriptions recorded in these case reports with the Russian Society of Cardiology (RSC) Guidelines was assessed.Results This study included 108 physicians (mean age, 44.0±13.1 years, 87.0 % women) who provided case reports of 341 patients (mean age, 64.4±13.2 years, 59.5 % women) with most common diagnoses of arterial hypertension (92.1 %), ischemic heart disease (60.7 %), and chronic heart failure (32.8 %). According to results of multivariate regression analysis, the following factors increased the likelihood of the prescription inconsistency with the guidelines: the fact that the physician had the highest attestation category (OR 2.56; 95% CI 1.39-4.7; p<0.002), attended professional events less than 2 times in 5 years (OR 2.23; 95% CI 1.18-4.22; p=0.013), had an additional, part-time job (OR 15.58; 95% CI 1.51-160.5; p=0.021), was prone to prescribe familiar trade names (OR 2.04, 95% CI 1.08-3.85; p = 0.028), perceived drug supply problems as an important factor influencing the decision making (OR 5.13, 95% CI 2.69-9.75; p<0.001), and a total score on the emotional exhaustion scale (OR 1.03, 95 % CI 1.01-1.06; р=0.031). Also, this likelihood was increased by older age of the patient (OR 3.29; 95 % CI 1.65-6.55; р<0.001) and excessive alcohol consumption by the patient (OR 1.79, 95 % CI 1.31-2.43; р<0.001). The likelihood of non-compliance with the guidelines was reduced by a high assessment of own health status according to the WHOQOL-BREF questionnaire (OR 0.19; 95% CI 0.05-0.72; p = 0.014), a high assessment of own working conditions (OR 0.76; 95% CI 0.64-0.9; p=0.002), and postgraduate education within the last 5 years (OR 0.14; 95% CI 0.06-0.36; p<0.001).Conclusion The study identified the factors that influence the likelihood of the consistency of prescriptions made by outpatient physicians for patients with CVD with applicable national clinical guidelines. Among these factors, the most important ones were access to educational events, additional, external part-time job, indicators of inertia of previous practice, problems with drug provision, satisfaction with own health status and working co
目的探讨影响门诊医师在常见心血管疾病(cvd)患者诊治中实际处方与国家适用指南一致性的因素。材料和方法本研究是一项横断面研究,随机选择16个城市综合诊所,内科医生填写有效问卷,包括Maslach倦怠量表-人类服务调查(MBI-HSS)、医院焦虑和抑郁量表(HADS)、视觉模拟量表(VAS)、世卫组织生活质量-BREF (WHOQOL-BREF)和个人决策因素(PDF-25)。参与医生提供连续到达的心血管疾病高风险或确诊心血管疾病患者在2-3个工作日内的门诊病例报告,对应于问卷周期±1周。评估了这些病例报告中记录的处方与俄罗斯心脏病学会(RSC)指南的一致性。结果本研究纳入108名医生(平均年龄44.0±13.1岁,女性占87%),提供了341例患者(平均年龄64.4±13.2岁,女性占59.5%)的病例报告,其中最常见的诊断为动脉高血压(92.1%)、缺血性心脏病(60.7%)和慢性心力衰竭(32.8%)。多因素回归分析结果显示,以下因素增加了处方与指南不一致的可能性:医生拥有最高的认证类别(OR 2.56;95% ci 1.39-4.7;p<0.002), 5年内参加专业活动少于2次(OR 2.23;95% ci 1.18-4.22;p=0.013),有额外的兼职工作(OR 15.58;95% ci 1.51-160.5;p=0.021),倾向于规定熟悉的商品名称(OR 2.04, 95% CI 1.08-3.85;p = 0.028),感知药品供应问题是影响决策的重要因素(OR 5.13, 95% CI 2.69-9.75;p<0.001),情绪衰竭量表总分(OR 1.03, 95% CI 1.01-1.06;р= 0.031)。此外,这种可能性随着患者年龄的增长而增加(OR 3.29;95% ci 1.65-6.55;(r <0.001)和患者过度饮酒(OR 1.79, 95% CI 1.31-2.43;р< 0.001)。根据WHOQOL-BREF问卷对自身健康状况进行高度评估(OR 0.19;95% ci 0.05-0.72;p = 0.014),对自己工作条件的高度评价(OR 0.76;95% ci 0.64-0.9;p=0.002),近5年内的研究生教育(OR 0.14;95% ci 0.06-0.36;p < 0.001)。结论本研究确定了影响门诊医生为心血管疾病患者开具处方与国家临床指南一致性可能性的因素。在这些因素中,最重要的是参加教育活动的机会、额外的外部兼职工作、以前执业的惰性指标、药物供应的问题、对自身健康状况和工作条件的满意度、情绪疲惫(职业倦怠的一个组成部分)、患者年龄较大和过度饮酒。
{"title":"[Factors affecting the uptake of national practice guidelines by physicians treating common CVDS in out-patient settings].","authors":"N. Pogosova, S. Isakova, O. Sokolova, A. Ausheva, R. Zhetisheva, A. Arutyunov","doi":"10.18087/cardio.2022.5.n1945","DOIUrl":"https://doi.org/10.18087/cardio.2022.5.n1945","url":null,"abstract":"Aim To study factors that influence the consistency of real prescriptions with applicable national guidelines for outpatient physicians in the management of patients with common cardiovascular diseases (CVDs).Material and methods This was a cross-sectional study based on 16 randomly selected municipal polyclinics, where internists filled in validated questionnaires, including the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), Hospital Anxiety and Depression Scale (HADS), Visual Analogue Scale (VAS), WHO Quality of Life - BREF (WHOQOL-BREF), and the Personal Decision-Making Factors (PDF-25). Participating physicians provided outpatient case reports of sequentially arriving patients with a high risk of CVD or confirmed CVDs during 2-3 working days, corresponding to the questionnaire period of ±1 week. The consistency of the prescriptions recorded in these case reports with the Russian Society of Cardiology (RSC) Guidelines was assessed.Results This study included 108 physicians (mean age, 44.0±13.1 years, 87.0 % women) who provided case reports of 341 patients (mean age, 64.4±13.2 years, 59.5 % women) with most common diagnoses of arterial hypertension (92.1 %), ischemic heart disease (60.7 %), and chronic heart failure (32.8 %). According to results of multivariate regression analysis, the following factors increased the likelihood of the prescription inconsistency with the guidelines: the fact that the physician had the highest attestation category (OR 2.56; 95% CI 1.39-4.7; p<0.002), attended professional events less than 2 times in 5 years (OR 2.23; 95% CI 1.18-4.22; p=0.013), had an additional, part-time job (OR 15.58; 95% CI 1.51-160.5; p=0.021), was prone to prescribe familiar trade names (OR 2.04, 95% CI 1.08-3.85; p = 0.028), perceived drug supply problems as an important factor influencing the decision making (OR 5.13, 95% CI 2.69-9.75; p<0.001), and a total score on the emotional exhaustion scale (OR 1.03, 95 % CI 1.01-1.06; р=0.031). Also, this likelihood was increased by older age of the patient (OR 3.29; 95 % CI 1.65-6.55; р<0.001) and excessive alcohol consumption by the patient (OR 1.79, 95 % CI 1.31-2.43; р<0.001). The likelihood of non-compliance with the guidelines was reduced by a high assessment of own health status according to the WHOQOL-BREF questionnaire (OR 0.19; 95% CI 0.05-0.72; p = 0.014), a high assessment of own working conditions (OR 0.76; 95% CI 0.64-0.9; p=0.002), and postgraduate education within the last 5 years (OR 0.14; 95% CI 0.06-0.36; p<0.001).Conclusion The study identified the factors that influence the likelihood of the consistency of prescriptions made by outpatient physicians for patients with CVD with applicable national clinical guidelines. Among these factors, the most important ones were access to educational events, additional, external part-time job, indicators of inertia of previous practice, problems with drug provision, satisfaction with own health status and working co","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"7 1","pages":"33-44"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88942809","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 : 2022-05-31DOI: 10.18087/cardio.2022.5.n1755
N. B. Perpech, A. Tregubov, I. E. Mikhailova
Aim To evaluate the physician's knowledge of basic provisions of clinical guidelines for diagnosis and treatment of chronic heart failure (CHF) and to determine how the actions of physicians in their everyday clinical practice comply with these provisions.Materials and methods The study analyzed anonymous questionnaires of 185 physicians (127 cardiologists, 40 internists and general practitioners, 18 other specialists) who were trained in advanced training programs during the 2020/2021 academic year. The main part of the questionnaire included 15 questions related to the classification, diagnosis, pharmacotherapy, and the use of implantable devices in the treatment of patients with CHF.Results The results showed that internists were less than cardiologists aware of major provisions of clinical guidelines for diagnosis and treatment of CHF. However, the knowledge of cardiologists could not be considered sufficient either. 57.5% of internists and 30% of cardiologists incorrectly indicated the main echocardiographic criterion for diagnosis of CHF with reduced left ventricular ejection fraction (CHFrEF). More than 40% of internists did not consider fluid retention with development of the congestion syndrome as a mandatory condition for administration of a loop diuretic to a patient with CHFrEF. 34.6% of cardiologists and 25% of internists correctly determined the indication for the administration of mineralocorticoid receptor antagonists. 37.6% of internists and 21.1% of cardiologists incorrectly indicated the dose of spironolactone recommended for achieving the neuromodulation effect. In determining doses of angiotensin-converting enzyme (ACE) inhibitors and beta-blockers, after arriving at which it is necessary to stop their up-titration, most of the physicians preferred to be based on systolic blood pressure (SBP) rather than on symptoms of hypotension. However, among therapists there were doctors for whom the patient's well-being and clinical symptoms, and not the level of SBP, were priority factors for choosing the tactics of the treatment with ACE inhibitors and beta-blockers. Physicians of both specialties were poorly familiar with indications for cardioverter defibrillator implantation; only 14.2% of cardiologists and 5% of internists chose the correct wording of indications.Conclusion The insufficient knowledge should be considered the basis for the low adherence of doctors to guidelines for diagnosis and treatment of CHF. When developing programs for advanced training of physicians in CHF, special attention should be paid to the use of renin-angiotensin-aldosterone system inhibitors and beta-blockers with detailed discussion of the dosing principles as well as of indications for implantation and results of using cardioverter defibrillators.
{"title":"[Physicians' adherence to the guidelines on the chronic heart failure diagnosis and treatment].","authors":"N. B. Perpech, A. Tregubov, I. E. Mikhailova","doi":"10.18087/cardio.2022.5.n1755","DOIUrl":"https://doi.org/10.18087/cardio.2022.5.n1755","url":null,"abstract":"Aim To evaluate the physician's knowledge of basic provisions of clinical guidelines for diagnosis and treatment of chronic heart failure (CHF) and to determine how the actions of physicians in their everyday clinical practice comply with these provisions.Materials and methods The study analyzed anonymous questionnaires of 185 physicians (127 cardiologists, 40 internists and general practitioners, 18 other specialists) who were trained in advanced training programs during the 2020/2021 academic year. The main part of the questionnaire included 15 questions related to the classification, diagnosis, pharmacotherapy, and the use of implantable devices in the treatment of patients with CHF.Results The results showed that internists were less than cardiologists aware of major provisions of clinical guidelines for diagnosis and treatment of CHF. However, the knowledge of cardiologists could not be considered sufficient either. 57.5% of internists and 30% of cardiologists incorrectly indicated the main echocardiographic criterion for diagnosis of CHF with reduced left ventricular ejection fraction (CHFrEF). More than 40% of internists did not consider fluid retention with development of the congestion syndrome as a mandatory condition for administration of a loop diuretic to a patient with CHFrEF. 34.6% of cardiologists and 25% of internists correctly determined the indication for the administration of mineralocorticoid receptor antagonists. 37.6% of internists and 21.1% of cardiologists incorrectly indicated the dose of spironolactone recommended for achieving the neuromodulation effect. In determining doses of angiotensin-converting enzyme (ACE) inhibitors and beta-blockers, after arriving at which it is necessary to stop their up-titration, most of the physicians preferred to be based on systolic blood pressure (SBP) rather than on symptoms of hypotension. However, among therapists there were doctors for whom the patient's well-being and clinical symptoms, and not the level of SBP, were priority factors for choosing the tactics of the treatment with ACE inhibitors and beta-blockers. Physicians of both specialties were poorly familiar with indications for cardioverter defibrillator implantation; only 14.2% of cardiologists and 5% of internists chose the correct wording of indications.Conclusion The insufficient knowledge should be considered the basis for the low adherence of doctors to guidelines for diagnosis and treatment of CHF. When developing programs for advanced training of physicians in CHF, special attention should be paid to the use of renin-angiotensin-aldosterone system inhibitors and beta-blockers with detailed discussion of the dosing principles as well as of indications for implantation and results of using cardioverter defibrillators.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"50 1","pages":"53-61"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85708499","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 : 2022-05-31DOI: 10.18087/cardio.2022.5.n1825
V. Agapov, Y. Kudryashov, I. V. Graifer, V. Samitin
Aim To evaluate the efficacy of remote monitoring by the compliance with body weight control and drug therapy in patients with CHF, using a specially developed software module for chronic heart failure (CHF) monitoring.Material and methods During 2018-2020, 79 patients with dilated cardiomyopathy (mean age, 36.1 [34.2; 38.4] years) and NYHA II-IV functional class CHF were included in the outpatient telemonitoring (TM) program.Results The duration of monitoring was 965 [768; 1065] days. During the monitoring time, the compliance with outpatient body weight control significantly improved: 73.3 [70; 80] % at baseline vs. 86.7 [76.7; 86.7] % at the end of the 31st month (p<0.001). The proportion of patients measuring their body weight at least 6 times a week significantly increased: 8.9 % at baseline vs. 58.1 % by the end of the monitoring (p<0.001). There was no significant association between the time-related changes in the compliance with body weight control and drug therapy and the patient's gender. In addition, during long-term TM, a small but statistically significant increase in left ventricular ejection fraction was noted (36.3 [35.5; 37.2] % at baseline vs. 37.2 [35.8; 38.3] % at the end of monitoring; p=0.0008). The involvement of staff physicians in the remote correction of therapy for CHF decreased during the study: the number of system notifications that required a physician's response reduced over two years from 26.6 to 13 % (p=0.011).Conclusion Participation of patients with dilated cardiomyopathy and CHF in the structured TM program was associated with a significant increase in the compliance with regular self-control of body weight and drug therapy for heart failure.
{"title":"[Development and implementation of a heart failure telemonitoring system: the single centre experience].","authors":"V. Agapov, Y. Kudryashov, I. V. Graifer, V. Samitin","doi":"10.18087/cardio.2022.5.n1825","DOIUrl":"https://doi.org/10.18087/cardio.2022.5.n1825","url":null,"abstract":"Aim To evaluate the efficacy of remote monitoring by the compliance with body weight control and drug therapy in patients with CHF, using a specially developed software module for chronic heart failure (CHF) monitoring.Material and methods During 2018-2020, 79 patients with dilated cardiomyopathy (mean age, 36.1 [34.2; 38.4] years) and NYHA II-IV functional class CHF were included in the outpatient telemonitoring (TM) program.Results The duration of monitoring was 965 [768; 1065] days. During the monitoring time, the compliance with outpatient body weight control significantly improved: 73.3 [70; 80] % at baseline vs. 86.7 [76.7; 86.7] % at the end of the 31st month (p<0.001). The proportion of patients measuring their body weight at least 6 times a week significantly increased: 8.9 % at baseline vs. 58.1 % by the end of the monitoring (p<0.001). There was no significant association between the time-related changes in the compliance with body weight control and drug therapy and the patient's gender. In addition, during long-term TM, a small but statistically significant increase in left ventricular ejection fraction was noted (36.3 [35.5; 37.2] % at baseline vs. 37.2 [35.8; 38.3] % at the end of monitoring; p=0.0008). The involvement of staff physicians in the remote correction of therapy for CHF decreased during the study: the number of system notifications that required a physician's response reduced over two years from 26.6 to 13 % (p=0.011).Conclusion Participation of patients with dilated cardiomyopathy and CHF in the structured TM program was associated with a significant increase in the compliance with regular self-control of body weight and drug therapy for heart failure.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"64 1","pages":"45-52"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86975171","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 : 2022-05-31DOI: 10.18087/cardio.2022.5.n1810
D. Sokolov, E. Zhelyakov, V. V. Koval’chuk, N. V. Kondratova, V. A. Snezhitskij, L. V. Kalatsei, Y. Belenkov, A. Ardashev
Hereditary motor and sensory type 1A neuropathy (known as Charcot-Marie-Tooth disease) is a disease of peripheral nerves characterized by symptoms of progressive polyneuropathy with preferential damage of distal extremity muscles. Damage to the cardiovascular system is extremely rare and heterogenous in this pathology. This disease is not included in the list of indications for interventional antiarrhythmic aid. We could not find in available literature a clinical description of the development of sinus node dysfunction associated with this pathology. The present clinical report presents a case of detection and successful treatment of a damage to the cardiovascular system that manifested itself as sinus node dysfunction/sick sinus syndrome in the tachy-brady variant. A combination treatment approach using radiofrequency catheter ablation, implantation of a permanent pacemaker, and antiarrhythmic therapy associated with drug and non-drug treatment of motor sensory neuropathy resulted in recovery and long-term maintenance of sinus rhythm as well as in beneficial changes in the patient's neurological status.
遗传性运动和感觉1A型神经病(又称charcott - marie - tooth病)是一种周围神经疾病,其特征是进行性多神经病变,优先损害远端肢体肌肉。在这种病理中,对心血管系统的损害是极其罕见和异质性的。此病不包括在介入抗心律失常辅助的适应症清单中。我们无法在现有文献中找到与此病理相关的窦结功能障碍发展的临床描述。目前的临床报告提出了一个病例的检测和成功的治疗损害心血管系统表现为窦结功能障碍/病态窦综合征的变异型。采用射频导管消融、植入永久性起搏器、抗心律失常治疗以及运动感觉神经病变的药物和非药物治疗相结合的联合治疗方法,可恢复和长期维持窦性心律,并使患者的神经状态得到有益的改变。
{"title":"[Clinical case of the cardiovascular system involvement in a patient with Charcot-Marie-Tooth disease].","authors":"D. Sokolov, E. Zhelyakov, V. V. Koval’chuk, N. V. Kondratova, V. A. Snezhitskij, L. V. Kalatsei, Y. Belenkov, A. Ardashev","doi":"10.18087/cardio.2022.5.n1810","DOIUrl":"https://doi.org/10.18087/cardio.2022.5.n1810","url":null,"abstract":"Hereditary motor and sensory type 1A neuropathy (known as Charcot-Marie-Tooth disease) is a disease of peripheral nerves characterized by symptoms of progressive polyneuropathy with preferential damage of distal extremity muscles. Damage to the cardiovascular system is extremely rare and heterogenous in this pathology. This disease is not included in the list of indications for interventional antiarrhythmic aid. We could not find in available literature a clinical description of the development of sinus node dysfunction associated with this pathology. The present clinical report presents a case of detection and successful treatment of a damage to the cardiovascular system that manifested itself as sinus node dysfunction/sick sinus syndrome in the tachy-brady variant. A combination treatment approach using radiofrequency catheter ablation, implantation of a permanent pacemaker, and antiarrhythmic therapy associated with drug and non-drug treatment of motor sensory neuropathy resulted in recovery and long-term maintenance of sinus rhythm as well as in beneficial changes in the patient's neurological status.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"9 1","pages":"67-71"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82494683","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 : 2022-05-31DOI: 10.18087/cardio.2022.5.n1779
E. Tarlovskaya, J. Dorofeeva
Aim To evaluate the quality of antithrombotic therapy (ATT) in patients with atrial fibrillation (AF) after acute coronary syndrome (ACS) at stage 3 of rehabilitation.Material and methods The registry included 163 patients with AF (mean age, 65.0 [59.0; 72.0] years; 55.8 % men) undergoing rehabilitation after ACS (ACS <1 month ago) in the hospital of the Kirov State Medical University.Results Recommendations for 73.6 % of patients on ATT provided upon discharge from the hospital after stage 2 of rehabilitation were consistent with clinical guidelines (CG). During the entire stage 3, 25.8% of patients had acute cardiovascular complications (CVC) or urgent interventions (8.0% died). Furthermore, the ATT was actually consistent with CG only in 9.2 % of patients; in 21.5 %, errors in changing the ATT timing were detected; and in 84.1 %, various mistakes in the control of international normalized ratio were observed. On the whole, 3.6% of patients incorrectly adjusted their ATT independently, and for 15.3%, the attending physician made incorrect APT adjustments.Conclusion In AF patients after ACS who were undergoing stage 3 of rehabilitation, the quality of the ATT was low despite the recommendations at discharge from the hospital, which depended not only on the patient but also on the attending physician.
{"title":"[Adherence of patients with atrial fibrillation after acute coronary syndrome to antithrombotic therapy at stage III of cardiac rehabilitation: data from the local register of the Kirov region].","authors":"E. Tarlovskaya, J. Dorofeeva","doi":"10.18087/cardio.2022.5.n1779","DOIUrl":"https://doi.org/10.18087/cardio.2022.5.n1779","url":null,"abstract":"Aim To evaluate the quality of antithrombotic therapy (ATT) in patients with atrial fibrillation (AF) after acute coronary syndrome (ACS) at stage 3 of rehabilitation.Material and methods The registry included 163 patients with AF (mean age, 65.0 [59.0; 72.0] years; 55.8 % men) undergoing rehabilitation after ACS (ACS <1 month ago) in the hospital of the Kirov State Medical University.Results Recommendations for 73.6 % of patients on ATT provided upon discharge from the hospital after stage 2 of rehabilitation were consistent with clinical guidelines (CG). During the entire stage 3, 25.8% of patients had acute cardiovascular complications (CVC) or urgent interventions (8.0% died). Furthermore, the ATT was actually consistent with CG only in 9.2 % of patients; in 21.5 %, errors in changing the ATT timing were detected; and in 84.1 %, various mistakes in the control of international normalized ratio were observed. On the whole, 3.6% of patients incorrectly adjusted their ATT independently, and for 15.3%, the attending physician made incorrect APT adjustments.Conclusion In AF patients after ACS who were undergoing stage 3 of rehabilitation, the quality of the ATT was low despite the recommendations at discharge from the hospital, which depended not only on the patient but also on the attending physician.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"45 1","pages":"27-32"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85216633","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 : 2022-05-31DOI: 10.18087/cardio.2022.5.n1977
N. G. Lozhkina, A. Spiridonov
Metabolic syndrome is a disease the World Health Organization has called a new pandemic of the 21st century. Arterial hypertension is one of the criteria for this diagnosis and a determinant of damage to major target organs. The present clinical case demonstrates an experience of treatment of arterial hypertension associated with metabolic syndrome with a valsartan/sacubitril molecular complex.
{"title":"[Clinical case: early connection of valsartan/sacubitril in the treatment of hypertension].","authors":"N. G. Lozhkina, A. Spiridonov","doi":"10.18087/cardio.2022.5.n1977","DOIUrl":"https://doi.org/10.18087/cardio.2022.5.n1977","url":null,"abstract":"Metabolic syndrome is a disease the World Health Organization has called a new pandemic of the 21st century. Arterial hypertension is one of the criteria for this diagnosis and a determinant of damage to major target organs. The present clinical case demonstrates an experience of treatment of arterial hypertension associated with metabolic syndrome with a valsartan/sacubitril molecular complex.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"5 1","pages":"72-74"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88225689","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}