Young ambulatory patients with cardiovascular diseases: age and gender characteristics, comorbidity, medication and outcomes (according to RECVASA register)

Estimation of the 10-year survival prediction in the unorganized of the working age males and females population in the Vladimir region

Objective. To estimate the predicted 10-year survival rate in the unorganized population of males and females of working age in the Vladimir region. Materials and methods. In five cities of the Vladimir region (Vladimir, Kovrov, Murom, Yuryev-Polsky and Vyazniki), a cross-sectional population study was conducted from May 2018 to March 2020. In six medical institutions, nine therapeutic sites were selected, and according to the lists of the registered population aged 30—69 years, respondents were invited to the study from each site. The response rate was 87%. A total of 1.174 subjects completed the study, including 424 (36.1%) males and 750 (63.9%) females. The respondents were interviewed using a standard questionnaire developed by the National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia. The questionnaire included information on socio-demographic indicators, behavioral risk factors, the presence of somatic diseases and illicit drug use. Instrumental and laboratory tests specified for the first stage of the check-up were performed. The Charlson comorbidity index was used to assess the 10-year survival of individuals. Results. A combination of three somatic diseases was observed in every eighth male and twice less frequently in females (p=0.0006). Based on the frequency of combination and the severity of somatic diseases, one in ten males had a low predicted survival rate in the next 10 years. In females, the frequency of predicted low 10-year survival was 1/3 less (p=0.03). 40% of respondents had an average predicted 10-year survival due to a combination of two or more diseases. The analysis of the predicted frequency of low 10-year survival in different cities showed its low variability. However, in Vladimir and Kovrov, the proportion of males with a low 10-year survival rate was 3—4% higher compared to the other three cities. A similar trend in the predicted low survival of females was observed in Vladimir and Vyazniki. Conclusion. In the unorganized population, the frequency of combination of three somatic diseases in males is 2 times higher than in females. The predicted low 10-year survival rate is determined in every tenth male and slightly less frequent in females.

Possibilities and limitations of secondary prevention of chronic non-communicable diseases in primary care of Russia and CIS countries

Objective. To analyze the possibilities and limitations of implementation of secondary prevention of chronic non-communicable diseases (CNCDs) in primary care in cities in the Russian Federation and 4 CIS countries based on a survey of doctors. Material and methods. The study involved doctors of outpatient-polyclinic facilities from 16 cities in the Russian Federation and 6 major cities in 4 CIS countries (Kyrgyz Republic, Republic of Belarus, Republic of Kazakhstan, Republic of Azerbaijan). The survey was organized on a questionnaire prepared by «National Medical Research Center for Therapy and Preventive Medicine», which included 11 blocks of questions. Multiple choice for each question is provided. Results. Men aged 50—59 years prevailed among patients, who were observed in outpatient clinics of five countries. Men aged over 65 years made up 30 and 40% respectively in the samples from the Russian Federation and the Republic of Azerbaijan, and only one fifth — in the samples from the other three countries. Men aged 40—50 years were ranked second for frequency of uptake in the samples from Republic of Kazakhstan and Republic of Belarus. The frequency of uptake among women was comparable in the age ranges of 50—59 years, as well as 60—65 years and older in samples from the Russian Federation, Republic of Belarus and Republic of Azerbaijan. Chronic forms of ischemic heart disease ranked first among CNCDs in terms of uptake (56% on average), the second place is occupied by the type 2 diabetes mellitus (27% on average). At least partial coverage by preferential drugs was provided according to the doctors in most of the considered samples from CIS countries; 100% coverage supplied the needs up to 40% in three CIS countries, this indicator was 2 times less in other countries. In the Kyrgyz Republic and Republic of Azerbaijan, 50% of the target level was reached. The situation was slightly better in the other three countries, with doctors reporting 75% of the target level reaching for the main risk factors. In all countries, about 30% of the cases were without problems with hospitalization, partial difficulties prevailed in the rest of the cases. An incomplete coverage by doctors in the staffing list in the analyzed countries has been noted, and there has been a significant shortage of doctors in the Russian Federation and Republic of Kazakhstan. The similar picture has been observed regarding the nursing staff. Conclusion. Systematic screening and regular medical check-up of adults are necessary, especially in the age group of 40—49 years for men and 50—59 years for women with regard to the significant role of chronic non-communicable diseases in the development of complications and mortality in CIS countries. Measures to increase adherence to the treatment, that affects the achievement of target levels of major risk factors, should be taken. The increase of preferential provision of pharmaceutical products and the organization of health-promoting schools for patients with chronic non-communicable diseases are important measures. In most CIS countries, the increase of the staffing list coverage by doctors and nursing staff can improve the implementation of secondary prevention of chronic non-communicable diseases.

Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines

Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.

[Problems of insufficient control of target blood pressure levels in the outpatient practice]

AIM

Assessment of the frequency of reaching the target level of blood pressure (BP) and the factors affecting it in outpatients with arterial hypertension (AH).

MATERIALS AND METHODS

An open, one-stage, comparative study involving 64 patients with hypertension and 47 without hypertension at the age of 40 to 59 years. All patients underwent physical examination, assessment of cardiovascular risk (CVR), 24-hour blood pressure monitoring (ABPM), echocardiography (ECHOCG), color duplex scanning of brachiocephalic arteries.

RESULTS

Patients with hypertension and comparison groups were comparable in age, sex, smoking, history of myocardial infarction. 1st degree of hypertension was present in 26.6%, 2nd in 40.6%, 3rd in 12.5% of patients. Obesity was detected in 24.3% of patients and all patients with obesity had AH. The SCORE score in individuals with hypertension was 4.94.5; in the comparison group, 2.32.6 (p0.001). Non-stenosing atherosclerosis was present in 54.8% and 88%, p=0.020, and atherosclerotic plaque in the vascular lumen was present in 45.3% and 12% of patients with and without hypertension, respectively (p0.001). 68.8% were constantly treated, and the target BP was reached in 31.3% of patients with hypertension. Male gender (OR 1.68; 95% CI 1.6828.49; p=0.007), obesity (OR 4.78; 95% CI 1.1420.29; p=0.033), concomitant pathology (OR 3.09; 95% CI 1.029.37; p=0.046) were negative, and dyslipidemia (OR 0.10; 95% CI 0.010.84; p=0.033) was positive, affecting the achievement of the target level of blood pressure.

CONCLUSION

The target level of blood pressure was achieved in 31.3% of outpatients with hypertension, mainly in women. Among patients who did not reach the target level of blood pressure, men, individuals with high SSR and obesity predominated. Concomitant pathology and obesity are negative, and dyslipidemia was positively associated with the achievement of the target level of blood pressure, which must be taken into account when developing measures for prevention and treatment.