The Efficacy of Telemedicine Rehabilitation Programs In Regard Of Risk Factors Control In Patients With Paroxysmal Atrial Fibrillation Aftercatheter Ablation

Aim      To evaluate changes in traditional risk factors (RF) during cardiac rehabilitation (CR) programs with remote support in patients with paroxysmal atrial fibrillation (AF) after catheter ablation (CA).Material and methods  The lack of control of cardiovascular RFs is a predictor for AF recurrence after CA, development of complications, and decreased life expectancy. Telemedical CR programs may improve the control of RF and enhance the CR efficacy. This randomized controlled clinical study in three parallel groups included 135 patients aged 35 to 79 years. In groups 1 and 2, CR programs with remote support were performed, which included a single personal consulting for the disease, achieving control of all patient's RFs, and remote support during 3 months (group 1, by phone and group 2, by e-mail). Participants of group 3 received standard recommendations. Body weight, blood pressure (BP), blood lipids, smoking status, and physical activity (PA) were determined at baseline and at 12 months after CA with the IPAQ questionnaire.Results In both intervention groups at 12 months, there were positive changes in RF: body weight index decreased by 3.6 % in group 1 (р=0.01) and by 2.3 % in group 2 (р=0.002) vs. 0 in the control group; systolic BP decreased by 7.1 % (p<0.001) and 1.5 % (p=0.003) in groups 1 and 2 (vs. increases by 3.3 % in group 2); total cholesterol decreased by 9.4 % (p<0.001) and by 6.3 % (p=0.003), respectively, (vs. 0 in group 3); values of metabolic equivalents (METs) used for walking increased by 55.0 % (р=0.014), 75.0 % (р=0.001), and 1.4 % in groups 1, 2 and 3, respectively. No significant intergroup differences in the frequency of AF recurrence, repeated CA, and hospitalizations were found.Conclusion      CR programs with remote support provide improved control of BP, body weight, blood cholesterol, and AF in patients with AF after CA, according to the results of the one-year follow-up.

Efficacy of secondary prevention and rehabilitation programs with distant support in patients with atrial fibrillation after intervention procedures: impact on psychological status

Aim      To evaluate the effectivity of secondary prevention/rehabilitation programs with remote support for the psychological condition of patients with paroxysmal atrial fibrillation (AF) following interventional procedures (radiofrequency catheter ablation and cryoablation).

Material and methods  This prospective, controlled, randomized clinical study was performed in three parallel groups. Each group consisted of 45 patients with AF after interventional procedures. In groups 1 and 2, secondary prevention/rehabilitation programs with remote support were performed, including a single individual in-hospital counseling (on risk factors of AF and their control and on major aspects of the disease, treatment and prevention of complications) and three months of remote support (by phone in group 1 and by e-mail in group 2). Patients of group 3 (control group) received standard recommendations at discharge from the hospital. The psychological status was evaluated using the Hospital Anxiety and Depression Scale, the PHQ-9 questionnaire, the Spielberg-Hanin scale for reactive and personal anxiety, and the visual analogue scale for stress assessment. The follow-up duration was 12 months.

Results At the end of the follow-up period, the proportion of patients with anxiety symptoms considerably decreased in both intervention groups (р<0.001 for each group) and was significantly less than in the control group (р<0.001 for both comparisons). Also, in intervention group 1, the proportion of patients with clinically pronounced anxiety symptoms was significantly decreased. For 12 months of follow-up, the severity of depressive symptoms significantly decreased in all three groups. However, in both intervention groups, this decrease was significantly greater than in the control group (р<0.001 for group 1 and р=0.020 for group 2). In both intervention groups at 12 months, the stress level was significantly reduced whereas in the control group, it remained practically unchanged. The greatest (50% on average) decrease in the stress level was observed in intervention group 2.

Conclusion      Secondary prevention and rehabilitation programs with remote support during a 12-month follow-up resulted in improvement of the psychological status in patients with AF after interventional procedures.

[Factors affecting the uptake of national practice guidelines by physicians treating common CVDS in out-patient settings]

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&lt;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&lt;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&lt;0.001) and excessive alcohol consumption by the patient (OR 1.79, 95 % CI 1.31-2.43; р&lt;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&lt;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 conditions, and emotional exhaustion (a component of professional burnout), older age of patients and their excessive alcohol consumption.

Sequelae of COVID-19 at long-term follow-up after hospitalization

Aim. To assess long-term sequelae of COVID-19 in hospitalized patients at 3 to 7 months after discharge.

Material and Methods. The whole of 700 patients hospitalized to the temporary COVID-19 treatment center hosted by the FSBI “National Medical Research Center of Cardiology” of the Ministry of Health of Russia from April to June 2020 were invited to participate in a follow-up study. At 3-7 months after the index hospitalization, patients or their proxies were contacted via telephone in order to obtain information on their vital status, cardiovascular and other conditions or their complications, and new hospitalizations. In addition, patients were invited to an outpatient visit under the "COVID-19-follow-up" program, encompassing physical examination and a comprehensive battery of laboratory and instrumental tests, including spirometry, chest computed tomography (CT) and the six minute walk test (6MWT). Further, dyspnea was assessed using the mMRC (Modified Medical Research Council) Dyspnea Scale. 

Results: We were able to contact 87.4% (612/700) of patients or their proxies. At follow-up, 4.4% (27) patients died, of which 96.3% (26) had cardiovascular diseases (CVD). A total of 213 patients aged 19 to 94 years old (mean age 56.8±12.5, median 57 years [49.0; 64.0]; men, 55.4%) agreed come for an outpatient visit and to participate in the “COVID-19-follow-up” program. Since discharge, 8% (17) of patients required new hospitalizations, and more than a half of these patients (58.8%; 10/17) had CVD-related hospitalizations. A total of 8.4% (18) patients experienced worsening of hypertension, 9 (4.2%) patients had newly diagnosed hypertension, 2 (0.9%) – coronary artery disease patients experienced new/recurrent angina symptoms. 4 (1.9%) patients had newly diagnosed coronary artery disease, and one patient had an ischemic stroke. At the outpatient visit, 114 (53.5%) patients had some symptoms, most frequently, shortness of breath (33%), fatigue (27.4%), chest pain (11.3%), and abnormal heartbeats (8.5%). Based on the mMRC Scale, 59% of patients had dyspnea of varying severity. Most patients had a normal vital capacity (VC), which was moderately reduced in 3.3% and severely reduced in 0.5% of patients. Chest CT scans were obtained in 78 (36.6%) patients, whose worst lung damage scores during hospitalization were CT3 or CT4. One in ten patients (10.8%) with severe lung damage during acute infection had persisting ground glass opacities, 35.9% developed fibrotic changes, 79.6% of patients had linear or fine focal opacities. According to the 6MWT data, 12.3% of patients walked less than 70% of the predicted distance, 67% walked 71 to 99% of the predicted distance, and 20.7% of patients were able to walk 100% of their predicted distance.

Conclusion. These data suggest long-term negative sequelae of COVID-19 in more than half of hospitalized patients.

[New treatments and technologies in cardiac rehabilitation programs]

The article presents a review of literature data reflecting the relevance and modern views on the effectiveness and expediency of using various options for rehabilitation programs for cardiovascular diseases. The issues of the history of the development of cardiac rehabilitation both abroad and in Russia are consecrated. The article also presents alternative models for conducting cardiac rehabilitation, in particular, using remote and telemedicine technologies. The widespread use of smartphones and high-speed Internet access contributed to the further introduction and use of telemedicine technologies in cardiac rehabilitation. The article discusses the possibilities of telerehabilitation of cardiological patients and shows its comparable effectiveness with traditional cardiac rehabilitation.

Traditional risk factor control in the Russian cohort of the hospital arm of EUROASPIRE V survey as compared to the whole study population

Background

Regular monitoring of risk factors control in patients (pts) with atherosclerotic cardiovascular diseases is of paramount importance for interventions and policies targeting secondary prevention settings.

Purpose

To describe traditional risk factors control in men and women with history of acute coronary syndromes (ACS) or cardiac revascularization enrolled into the hospital care arm of EUROASPIRE V (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) study in Russian centers vs the whole study population.

Methods

The hospital arm of EUROASPIRE V was a cross sectional survey covering multiple European countries including Russia. Within each country one or more hospitals were selected where consecutive pts (both genders, ≥18 and &lt;80 years of age) hospitalized for myocardial revascularization procedures or for ACS were retrospectively identified. Identified patients were invited for interview, which had to take place ≥6 months and &lt;2 years after the index hospitalization. The risk factors control was assessed during the interview.

Results

A total of 399 pts (women, 27.1%) have been interviewed in Russia vs 8261 pts (women, 25.8%) in the whole survey. The mean age of the Russian cohort at interview was 62.8±8.7 years in Russia vs 63.6±9.6 years in all EUROASPIRE V pts. The proportion of pts with uncontrolled risk factors in Russia vs the whole survey population was as follows: current smokers 19.0% vs 18.7%, obesity 47.0% vs 37.7%, abdominal obesity 60.4% vs 58.5%, uncontrolled diabetes 52.9% vs 45.6%, blood pressure (BP) not at goal 36.0% vs 46.3% and uncontrolled LDL cholesterol in 72.4% vs 71.0%, respectively. The table below represents uncontrolled risk factors by gender in Russian pts and in the whole study population.

Conclusion

Both in Russian centers and in the whole survey participants there was a considerable room for improvement o risk factors control. Smoking seemed to be a more common issue in men whereas obesity, uncontrolled diabetes and low physical activity were more prevalent in women.

Funding Acknowledgement

Type of funding sources: None. Table 1

Current patterns of pharmacological treatment for coronary heart disease based on the Russian cohort of the hospital arm of the EUROASPIRE V survey

Background

Several drug classes have shown their ability to improve risk factors control and prognosis in coronary heart disease (CHD). Therefore, it is important to monitor the prescription patterns on a regular basis to ensure that all the eligible patients receive the potentially lifesaving medications.

Purpose

To describe prescription and uptake of main guideline-recommended drug classes in men and women with history of acute coronary syndromes (ACS) or cardiac revascularization enrolled into the hospital care arm of EUROASPIRE V (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) study in Russian centers vs the whole study population.

Methods

The hospital arm of EUROASPIRE V was a cross sectional survey covering multiple European countries including Russia. Within each country one or more hospitals were selected where consecutive pts (both genders, ≥18 and &lt;80 years of age) hospitalized for myocardial revascularization procedures or for ACS were retrospectively identified. Identified patients were invited for interview, which had to take place ≥6 months and &lt;2 years after the index hospitalization. Pharmacological treatment was assessed based on the prescriptions in the discharge letters and during the interview.

Results

A total of 399 pts (women, 27.1%) have been interviewed in Russia vs 8261 pts (women, 25.8%) in the whole survey. The mean age of the Russian cohort at interview was 62.8±8.7 years in Russia vs 63.6±9.6 years in all EUROASPIRE V pts. The table below represents the proportion of pts prescribed and actually receiving main drug classes. Both in the Russian cohort and in the whole study population the proportion of patients receiving essential drug classes didn't differ much by gender. In Russian centers, 95.9% of men and 91.7% of women received antiplatelets (vs 92.8% and 91.8%, respectively, in the whole study population). For statins the corresponding numbers were 86.9% for men and 91.7% for women in Russia (vs 82.2% and 76.8%), for beta-blockers – 82.5 in both genders (vs 80.8% and 81.8%), for ACE inhibitors and/or ARBs 78.0% in men and 80.6% in women (vs 75,3% and 75.0%).

Conclusion

Current prescription of guideline-recommended drug classes in the Russian cohort of EUROASPIRE V survey is close to the average European levels and doesn't demonstrate any obvious gender gaps. However, there is still room for improvement. In particular, this applies to the maintenance of prescriptions made at discharge, especially of statins, in the long term.

Funding Acknowledgement

Type of funding sources: None. Table 1

Drug Therapy and Adherence in Patients With Coronary Heart Disease: Results of the Russian Part of the EUROASPIRE V International Multicenter Study

Aim      To study the practice of drug treatment of ischemic heart disease (IHD) and the consistency of this practice with the established guidelines.Material and methods  Results of the Russian part of the EUROASPIRE V study were compared with the general European population of the study. At ≥6 mos. and &lt;2 years after the discharge from the hospital, patients were invited to visit the site for an interview. The drug therapy recommended upon discharge and taken by patients in the long-term as well as the patients' compliance with the treatment were analyzed. In Russian centers, 699 patients were registered, and 399 of them visited the centers for the interview.Results             Upon discharge from the hospital, patients of the Russian cohort and of the entire study population were prescribed acetylsalicylic acid or other antiplatelet drugs (99.2% and 94.1%, respectively); beta-blockers (87.2 and 81.6%, respectively); angiotensin-converting enzyme (ACE) inhibitors (69.9% and 61.1%, respectively); sartans (16.5% and 14.2 %, respectively); calcium channel blockers (19.3 and 19.4 %, respectively); nitrates (8.0% and 22.5 %, respectively); diuretics (31.1 and 32.5 %, respectively); statins (98.0% and 85.0 %, respectively); and anticoagulants (6.6 and 8.3 %, respectively). For the long-term treatment, patients of the Russian cohort and of the entire study population took antiplatelets (94.7 % and 92.5 %, respectively); beta-blockers (83.2% and 81.0 %, respectively); ACE inhibitors (60.2% and 57.3 %, respectively); sartans (19.3% and 18.4 %, respectively); calcium antagonists (21.1% and 23.0 %, respectively); nitrates (9.0% and 18.2 %, respectively); diuretics (31.8% and 33.3 %, respectively); statins (88.2% and 80.8 %, respectively); and anticoagulants (8.8% and 8.2 %, respectively). High intensity hypolipidemic therapy was prescribed to 54.0 % of patients in Russian centers and 60.3 % of patients in the entire study. Both Russian and international patients evaluated their compliance with the prescribed medication as high.Conclusion      According to results of the EUROASPIRE V study as compared to earlier studies, the practice of drug therapy in Russian patients with IHD has significantly approached European indexes. Further optimization is possible by a more extensive use of high intense hypolipidemic treatment and antidiabetic drugs with a documented positive effect on prognosis of cardiovascular diseases.

Occupational Burnout, Psychological Status and Quality of Life in Primary Care Physicians Working in Outpatient Settings

Aim      To study features of the psychological status, job burnout syndrome (JBS)m and quality of life (QoL) in outpatient physicians.Material and methods  This cross-sectional study was performed at 16 randomly selected municipal outpatient hospitals of Moscow and included physicians (district physicians, primary care physicians, and cardiologists). The participants signed an informed consent form and then filled out a registration card that included major social and demographic (sex, age, education, position) and professional characteristics (specialization, work experience, qualification category), and questionnaires. The degree of job burnout was evaluated with the Maslach Burnout Inventory (MBI-HSS), and the presence of anxio-depressive symptoms was evaluated with the Hospital Anxiety and Depression Scale (HADS). The level of stress was assessed with a visual analogue scale (VAS) in a score range from 0 to 10. The QoL of physicians was assessed with the short version of the World Health Organization Quality of Life (HOQOL-BREF) questionnaire.Results This study included 108 physicians from 16 municipal outpatient clinics aged 24 to 70 years (mean age, 44.0±13.1 years), mostly women (87.0 %). Among JBS components, a high level of emotional exhaustion was observed in 50.0 % of physicians, a high level of depersonalization in 34.1 %, and a severe reduction of personal accomplishment in 37.5 %. A high level of stress (VAS score ≥7) was observed in 66.3 % of physicians; symptoms of anxiety and depression of any degree (HADS-A and HADS-D subscale score ≥ 8) were found in 23.8 and 22.7 % of participants, respectively. 42.0% of physicians evaluated their QoL lower than "good" and 41.6% of physicians evaluated their health condition lower than "good". Most of the studied factors did not significantly depend on the gender and the duration of work, except for emotional exhaustion (55.3 % of women and 16.7 % of men; p=0.0086) and a high level of stress (72.2 % of women and 28.6 % of men; р=0.002).Conclusion      The study showed a high prevalence of personal factors that potentially adversely affect the work of outpatient physicians. These factors included high degrees of stress, anxio-depressive symptoms, job burnout, unsatisfactory QoL, and low satisfaction with own health. Management decisions and actions are required to create the optimum psychological climate at the workplace of physicians, to develop new strategies for prophylaxis and correction of their psychological condition, and to implement comprehensive programs for improving the professional environment to maintain and enhance the mental health and to increase the professional prestige of the medical speciality.

The impact of different preventive counseling programs on medication adherence in patients with paroxysmal atrial fibrillation after catheter ablation

Funding Acknowledgements

Type of funding sources: None.

Background

Poor medication adherence is a major contributor to suboptimal health outcomes and increased costs in cardiovascular (CV) diseases including atrial fibrillation (AF).

Purpose

To assess the impact of different preventive counseling programs on medication adherence in AF patients (pts) after catheter ablation (CA).

Methods

A prospective randomized controlled study with 3 parallel groups of pts with paroxysmal AF after CA (radiofrequency or cryoablation).  Pts were randomized (1:1:1) into 3 groups. Before discharge, pts from all groups received 1 preventive counseling session with focus on their individual risk factors profile. After discharge both intervention groups received 6 sessions of biweekly remote preventive counseling by phone (Group 1) or via email(Group 2) for 3 months after enrollment. Group 3 received usual care. Medication adherence was assessed using the 4-item Morisky-Green scale at baseline and at 12 months. 

Results

A total of 135 pts aged 35 to 80 years were enrolled (mean age, 57.3 ± 9.1 years, men, 51.8%). The groups were well balanced according to demographic and clinical features. Baseline levels of non-adherenсe and partial adherence were high in all groups (53.4%, 71.1% and 73.3% respectively). At 1 year of follow-up pts from both intervention groups demonstrated a significant improvement of medication adherence vs control (table). 

Conclusions

Preventive counseling programs with remote support via phone or e-mail improve medication adherence in AF pts after CA.

Мedication adherence 1 group (support via phone) 2 group (support via e-mail) Control group P for Group 1 vs. control at 12 months P for Group 2 vs. control at 12 months Baseline After 12 months Baseline After 12 months Baseline After 12 months Adherence,% 46.7 60 28.9 60 26.7 31.1 &lt;0.01 &lt;0.01 Partial adherence ,% 17.8 20 31.1 20 24.4 33.3 n/s n/s Non-adherence,% 35.6 60 40 20 48.9 35.6 n/s n/s

Prediction of subclinical coronary atherosclerosis in patients with high and very high cardiovascular risk

Funding Acknowledgements

Type of funding sources: None.

Background

Coronary atherosclerosis has a long subclinical period. It’s early detection may offer a possibility of timely initiation of preventive interventions

Purpose

To develop a diagnostic rule for detection of patients (pts) with high probability of subclinical atherosclerosis among those with high or very high cardiovascular (CV) risk.

Methods

This cross-sectional study enrolled 52 pts (32 men [62%]), aged 40 to 65 years [mean age 54.6 ± 8.0]) with high or very high CV risk (5-9 and ≥10% by The Systematic Coronary Risk Estimation Scale [SCORE], respectively). All participants underwent cardiac computed tomography (CT) angiography and calcium scoring. Traditional risk factors (RFs) (family history of premature CVD, smoking, overweight/obesity and abdominal obesity, hypertension, type 2 diabetes mellitus, lipids parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides) and lipids-related markers (apolipoprotein A1, apolipoprotein B, ApoB/ApoA1 ratio), biomarkers of inflammation (high-sensitivity C-reactive protein [hs CRP], fibrinogen), indicator carbohydrate metabolism (glucose),  ankle-brachial index,  stress-test, carotid plaques according to ultrasound were evaluated in all pts. Psychological RFs were evaluated using Hospital Anxiety and Depression Scale and DS-14 for type D personality.

Results

All pts were divided into 2 groups according to the CT angiography results: pts in the main group (n = 21) had any non-obstructive lesions or calcium score &gt;0, pts in the control group (n = 31) had intact coronary arteries. The groups did not differ in age or gender. 26 multiple linear logistic models for any subclinical atherosclerosis were developed based on obtained diagnostic features. Taking into account R-square = 0.344 (p = 0.0008), the best fitting model was follows: 

subclinical coronary atherosclerosis= -1.576 + 0.234 x SCORE ≥5%  + 0.541 x hs CRP &gt;2 g/l + 0.015 x heart rate  (bpm) + 0.311 family history of premature CVD. 

The developed algorithm had sensitivity of 63% and  specificity of 80%.

Conclusions

The created diagnostic model diagnostic model suggests the presence of subclinical coronary atherosclerosis in patients with high / very high CV risk with a high degree of probability. This easy-to-use method can be used in routine clinical practice to improve risk stratification and management choices in high-risk pts.

The effects of preventive counseling with remote support via e-mail on illness perception in patients with paroxysmal atrial fibrillation after catheter ablation

Funding Acknowledgements

Type of funding sources: None.

Background

Illness perception (IP) affects health behaviors and coping strategies in chronic diseases, but our knowledge about IP in atrial fibrillation (AF) patients (pts) after catheter ablation (CA) is limited.

Purpose

To assess the impact of preventive counseling on IP in pts after AF catheter ablation.

Methods

A prospective randomized controlled study with 2 parallel groups of pts with paroxysmal AF after CA (radiofrequency or cryoablation).  Pts were randomized (1:1) into 2 groups. Before discharge, both groups received 1 preventive counseling session with focus on their individual risk factors profile. After discharge pts from intervention group received 6 sessions of biweekly remote preventive counseling via e-mail over the first 3 months. Control group received usual care. IP was assessed using The Brief Illness Perception Questionnaire (BIPQ) at baseline and at 3, 6 and 12 months.

Results

A total of 90 pts aged 35 to 80 years were enrolled (mean age, 57.4 ± 9.9 years, men, 52.2%). The groups were well balanced according to demographic and clinical features. At 6 and 12 months of follow-up there was a significant improvement of the overall IP score in the intervention group vs control (table). 

Conclusions

Preventive counseling with remote support via e-mail improves IP in AF pts after CA which may contribute to better long term outcomes.

The overall score of IP Intervention group Control group P for change vs baseline Baseline (points) mean ± SD 42.2 ± 10.2 44.4 ± 9.5 n/s Mе (25%; 75%) 44 (35; 48.5) 45 (37; 51.5) At 3 months (points) mean ± SD 36.8 ± 8.1* 39.7 ± 7.9* 0.055 Mе (25%; 75%) 37 (33; 41) 41 (33.5; 47) Δ% after 3 months, Ме (25%; 75%) -14.3 (-23.2; 5.2) -13.0 (-16.8; -4.6) n/s At 6 months (points) mean ± SD 32.4 ± 7.3* 37.7 ± 8.7* 0.008 Mе (25%; 75%) 33 (27; 38) 37 (31; 44.5) Δ% after 6 months, Ме (25%; 75%) -24.2 (-33.7; -5.9) -18.4 (-24.0; -5.9) 0.040 At 12 months (points) mean ± SD 29.4 ± 7.6* 36.9 ± 8.2* &lt;0.001 Mе (25%; 75%) 29 (24.5; 33.5) 36 (31; 43) Δ% after 12 months, Ме -33.3 (-42.5; -17.1) -18.4 (-26.4; -7.5) &lt;0.001 SD – standard deviation, Me – median;* p &lt;0.001 vs baseline within group

The effects of different preventive counseling programs on physical activity in patients with paroxysmal atrial fibrillation after catheter ablation

Funding Acknowledgements

Type of funding sources: None.

Background

Physical activity (PA) is associated with lower risk of all-cause death in atrial fibrillation (AF), so interventions to increase PA in AF patients (pts) has a potential to improve their outcomes.

Purpose

To assess the impact of different preventive counseling programs on PA in pts after catheter ablation (CA) of paroxysmal AF.

Methods

A prospective randomized controlled study with 3 parallel groups of pts with paroxysmal AF after CA (radiofrequency or cryoablation).  Pts were randomized (1:1:1) into 3 groups. Before discharge, pts from all groups received 1 preventive counseling session with focus on their individual risk factors profile. After discharge both intervention groups received 6 sessions of biweekly remote preventive counseling by phone (Group 1) or via email(Group 2) for 3 months after enrollment. Group 3 received usual care. PA was assessed using the International Questionnaire on Physical Activity (IPAQ) at baseline and after 12 months.

Results

A total of 135 pts aged 35 to 80 years were enrolled (mean age, 57.3 ± 9.1 years, men, 51.8%). The groups were well balanced according to demographic and clinical features and PA level. The baseline proportion of pts with sufficient (moderate or high) PA was high in all 3 groups (86.6%, 88.9% and 91.1%, respectively). At 1 year of follow-up both intervention groups had a significantly higher proportion of pts maintaining high PA levels vs control (table). 

Conclusions

Preventive counseling programs combining in-hospital and remote counseling via phone or e-mailsupport higher physical activity levels in AF pts after CA.

Different counseling programs and PA Levels of physical activity 1 group (support via phone) 2 group (support via e-mail) Control group P for Group 1 vs. control at 12 Months P for Group 2 vs. control at 12 Months Baseline After 12 months Baseline After 12 months Baseline After 12 months Low,% 13.3 2.2 11.1 0 8.9 2.2 n/s n/s Moderate,% 62.2 71.1 71.1 82.2 60 93.3 &lt;0.01 n/s High,% 24.4 26.7 17.8 17.8 31.1 4.4 &lt;0.005 &lt;0.05

The effects of preventive counseling followed by remote support via phone on the motivation to change lifestyle in patients with high cardiovascular risk

Funding Acknowledgements

Type of funding sources: None.

Background

Personal motivation for lifestyle change plays a fundamental role in modifying unhealthy habits. It can be improved, for example, through education. 

Objectives

To assess the effects of preventive counseling with focus on diet modification followed by remote support via telephone on the motivation to change lifestyle in patients (pts) with high cardiovascular  risk in a long-term follow-up.

Methods

This is a prospective randomized controlled study of pts aged 40 to 65 years with high/very high CV risk (≥5% according to the Systematic Coronary Risk Evaluation scale [SCORE]) and any 2 criteria of metabolic syndrome.  Pts were randomized into 2 groups in 1:1 ratio. The intervention group received comprehensive preventive counseling with focus on diet modification followed by remote preventive counseling by phone every two weeks for the first 3 months after enrollment (a total of 6 sessions). The control group received usual care in Health centers which also included basic preventive counseling. A specially designed questionnaire was used to evaluate the motivation to change lifestyle at  baseline and 12 months.

Results

A total of 100 pts (women - 80%, aged 59.85 ± 4.47 years) were randomized. At baseline 81% pts had high and 19% - very high CV risk. The groups were well balanced according to demographic and clinical features. At 1 year of follow-up the intervention group experienced significant improvement in motivation for lifestyle changes vs control. The proportion of pts achieving advanced stages of change process was 38% vs. 12% in the control group where 82% of pts only continued to think of lifestyle modification.

Conclusion

Preventive counseling followed by remote support via phone provided a significant improvement in motivation to change lifestyle.

Intervention group Control group P for change from baseline Baseline After 12 months Baseline After 12 months Not ready yet, % 0 0 0 0 &lt;0.05 Often think of lifestyle changes, % 62 46 86 82 Ready to do changes if provided specific advices, % 32 16 12 6 Are in process of successful changes, % 6 38 2 12

Preventive counseling with subsequent remote support does not further improve the quality of life after catheter ablation of atrial fibrillation

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) is associated with substantially reduced quality of life (QoL). Both catheter ablation (CA) and education have a potential to improve QoL in AF patients (pts). 

Purpose

To assess the impact of preventive counseling with long-term support on QoL in pts after CA performed for paroxysmal AF.

Methods

A prospective randomized controlled study with 2 parallel groups of pts with paroxysmal AF after CA (radiofrequency or cryoablation).  Pts were randomized (1:1) into 2 groups. Before discharge, both groups received 1 preventive counseling session with focus on their individual risk factors profile. After discharge pts from intervention group received biweekly preventive counseling via email for 3 months (6 sessions). Control group received usual care. QoL was assessed at baseline and at 12 months using SF-36 questionnaire.

Results

A total of 90 pts aged 35 to 80 years were enrolled (mean age, 57.4 ± 9.9 years, men, 52.2%). Both groups had a poor QoL at baseline, and both groups experienced improvement in the physical health component at 1 year, but the degree of this improvement in the intervention group was similar to the control (table).

Conclusions

Preventive counseling with remote support via email does not further improve QoL in AF pts after CA.

Intervention group Control group P Integral component of physical health Baseline (points) mean ± SD 44.1 ± 7.9 40.2 ± 8.7 0.028 Mе (25%; 75%) 44.5 (38.7; 50.1) 38.6 (34.4; 47.1) At 12 months (points) mean ± SD 49.4 ± 6.0* 45.7 ± 7.7* 0.010 Ме (25%; 75%) 51.0 (45.2; 53.9) 46.3 (42.4; 50.6) Δ% after 12 months, Ме (25%; 75%) 11.8 (1.4; 32.7) 18.7 (-0.3; 30.4) n/s Integral component of mental health Baseline (points) mean ± SD 46.1 ± 9.0 45.0 ± 8.4 n/s Mе (25%; 75%) 47.8 (39.1; 53.9) 48.0 (37.2; 52.0) At 12 months (points) mean ± SD 48.2 ± 8.1 46.8 ± 8.7 n/s Ме (25%; 75%) 50.1 (46.1; 53.6) 48.0 (41.0; 54.3) Δ% after 12 months, Ме (25%; 75%) 3.6 (-10.8; 32.6) 8.9 (-15.6; 30.8) n/s * p &lt;0.001 vs baseline

The effects of preventive counseling followed by remote support via phone on physical activity in patients with high cardiovascular risk

Funding Acknowledgements

Type of funding sources: None.

Background

Education may increase physical activity (PA) in patients (pts) with high cardiovascular (CV) risk.

Objectives

To assess the effects of preventive counseling with focus on diet modification with remote support by phone on PA levels in high CV risk pts.

Methods

This is a randomized controlled study of pts aged 40 to 65 years with high/very high CV risk (Systematic Coronary Risk Evaluation scale [SCORE], ≥5%) and any 2 metabolic syndrome criteria.  Pts were randomized into 2 groups in 1:1 ratio. Intervention group received comprehensive preventive counseling with focus on healthy diet followed by 3 months of biweekly remote counseling by phone (a total of 6 sessions). Control group received usual care including basic preventive counseling. PA was assessed by International Questionnaire on Physical Activity (IPAQ) at baseline, at 6 and 12 months. 

Results

A total of 100 pts (women, 80%, aged 59.85 ± 4.47 years) were randomized. Demographics and clinical features were balanced across groups. Despite the study intervention not focusing on PA, total PA, moderate PA and walking significantly increased in the intervention group vs control at 6 and 12 months.

Conclusion

The study intervention provided a significant increase of PA in high CV risk pts.

Intervention group, mean ± standard deviation Control group, mean ± standard deviation P for change from baseline Total physical activities, МЕТ-min/week Baseline 1317.94 ± 1455.4 2029.42 ± 2811.84 After 6 months 2217.58 ± 1813.95*** 1793.26 ± 1863.54 &lt;0.001 After 12 months 2240.2 ± 1991.47*** 1629.48 ± 1629.02 &lt;0.001 Vigorous physical activities, МЕТ-min/week Baseline 92.8 ± 407.72 220.8 ± 881.49 After 6 months 96 ± 557.08 0 ± 0 n/s After 12 months 132.8 ± 425.66 27.2 ± 109.15 n/s Moderate physical activities, МЕТ-min/week Baseline 268.8 ± 455.28 714 ± 1390.22 After 6 months 522.4 ± 570.54*** 518.8 ± 1075.79* &lt;0.001 After 12 months 766.8 ± 1176.38** 481.6 ± 874.97* &lt;0.001 Walking, МЕТ-min/week Baseline 956.34 ± 1071.49 1094.62 ± 1344.46 After 6 months 1599.18 ± 1404.88*** 1294.46 ± 1208.88 &lt;0.05 After 12 months 1339.8 ± 1230.51** 1120.68 ± 1067.09 &lt;0.05 *р&lt;0,05;**р&lt;0,01;***р&lt;0,001 for within group comparisons vs baseline

[The Impact of Secondary Prevention Programs Incorporating Remote Technologies on Psychological Well-Being and Quality of Life in Coronary Heart Disease Patients with Abdominal Obesity]

BACKGROUND

Quality of life, which is determined both by the physical symptoms and by psychosocial risk factors, is among the primary treatment goals in coronary heart disease (CHD). Therefore, it is reasonable to assess the impact of any therapeutic interventions in CHD on these measures.

AIM

To assess the changes of psychological status and quality of life in patients with CHD and abdominal obesity (AO) over time during 2 secondary prevention programs using two different modalities of remote support.

METHODS

An open-label randomized study with 3 parallel groups enrolling hospitalized patients with stable CHD and AO (most hospitalizations were due to elective revascularization procedures). The patients were randomized into 2 intervention groups (Group I and Group II) and into Group III (control). Both intervention groups received secondary prevention programs including one in-hospital preventive counselling session with focus on healthy eating habits and subsequent remote support for 6 months (Month 1 to 3: once a week; Month 4 to 6: once a month). Group I received this subsequent counselling via phone calls and Group II received text messages via different platforms according to patient preferences. Group III received standard advice at discharge only. During 1 year of follow-up motivation for lifestyle changes and continued participation in secondary prevention programs, anxiety and depression symptoms (HADS), stress levels (10-point VAS) and quality of life (HeartQol) were assessed.

RESULTS

A total of 120 patients were enrolled (mean age±SD, 57.75±6.25 years; men, 83.4%) who had a high baseline motivation to participate in preventive programs. At 1 year of follow-up there was a substantial improvement in anxiety and depression symptoms in Groups I and II which was absent in Group III. As a result, the proportion of patients with HADS-A score ≥8 dropped from 45.0% to 10.0% in Group I and from 40.0% to 7.5% in Group II (both р values &lt;0.01 vs control), and the proportion of participants with HADS-D ≥8 decreased from 30.0% to 10.0% (р&lt;0.01 vs control) and from  12.5% to 0% (р&lt;0.05 vs control), respectively. Stress level decreased in Groups I and II by 3.95±0.38 and 3.56±0.39 баллов, respectively (both р values &lt;0.01 vs control). The HeartQol global score increased by 1.07±0.08 points in Group I and by 0.98±0.13 points in Group (both р values &lt;0.01 vs control).

CONCLUSION

Both secondary prevention programs with long-term remote support targeting obese CHD patients resulted in improvement of pivotal measures of their psychological status i.e. into a decline of anxiety and depression symptomatology, stress reduction and into a better quality of life.

P2511Effects of two different preventive counselling programs with remote support on salt and sodium-reach foods intake patterns in coronary patients with abdominal obesity

Background

Salt restriction is essential for a healthy diet, especially for patients (pts) with cardiovascular diseases. Pts education has a potential to promote healthier dietary patterns.

Purpose

To assess the impact of 2 preventive counselling programs with subsequent remote support resulted after hospitalization on salt intake in pts with coronary artery disease (CHD).

Methods

A prospective randomized parallel-group study in hospitalized nonsurgical pts with confirmed stable CHD and concomitant abdominal obesity. Most hospitalizations were due to elective percutaneous coronary intervention. Pts were randomized (1:1:1) into 3 groups. Before discharge, Groups 1 and 2 received comprehensive counselling with focus on diet followed by remote counselling by phone (Group 1) or via text messages (Group 2). Remote counselling was delivered weekly (Months 1–3) and then monthly (Months 4–6). Group 3 received standard advice only. Self-reported salt intake was assessed by consumption of sodium-reach foods such as sausages, pickles and by adding salt to cooked foods.

Results

A total of 120 pts (mean age±SD, 57,75±6,25 years, men, 83.4%) were enrolled. The Table presents self-reported dietary habits at baseline and at 12 months. At 1 year, significant improvements of relevant dietary habits vs control were seen in both intervention groups.

Group 1 Group 2 Group 3 (Control) Group 1 vs 3, Group 2 vs 3, (n=40) (n=40) (n=40) P for change from baseline P for change from baseline Pts adding salt to cooked foods at least sometimes   Baseline 87.5% 90.0% 85.0%   At 12 months 25.0%** 10.0%** 89.5% <0.01 <0.01 Pts avoiding pickled vegetables   Baseline 17.5% 20.0% 15.4%   At 12 months 62.5%* 77.5%** 7.9% <0.05 <0.01 Pts avoiding wurst, sausages, smoked meats   Baseline 0.0% 10.0% 7.5%   At 12 months 77.5%** 87.5%** 2.6% <0.01 <0.01 *p<0.05, **p<0.01 vs baseline within group.

Conclusion

Pre-discharge preventive counselling with subsequent remote support in coronary patients with abdominal obesity resulted in significant improvement of dietary habits in terms of salt and high-sodium foods intake.

P2512Effects of two different preventive counselling programs with remote support on added sugar and refined carbohydrates intake pattern in coronary patients with abdominal obesity

Background

Restricting added sugar and refined carbohydrates is essential for a healthy diet, especially for overweight or obese patients (pts). Pts education has a potential to improve dietary patterns in coronary artery disease (CHD).

Purpose

To assess the impact of 2 preventive counselling programs with subsequent remote support resulted after hospitalization on salt intake in pts with CHD and obesity.

Methods

A prospective randomized parallel-group study in hospitalized nonsurgical pts with confirmed stable CHD and concomitant abdominal obesity. Most hospitalizations were due to elective percutaneous coronary intervention. Pts were randomized (1:1:1) into 3 groups. Before discharge, Groups 1 and 2 received comprehensive counselling with focus on diet followed by remote counselling by phone (Group 1) or via text messages (Group 2). Remote counselling was delivered weekly (Months 1–3) and then monthly (Months 4–6). Group 3 received standard advice only. Self-reported sugar/refined carbohydrates intake was assessed by consumption of added sugar, sugar-sweetened beverages and pastry.

Results

A total of 120 pts (mean age±SD, 57.75±6.25 years, men, 83.4%) were enrolled. The table presents self-reported dietary habits at baseline and at 12 months. At 1 year, significant improvements of relevant dietary habits vs control were seen in both intervention groups.

Group 1 Group 2 Group 3 (control) Group 1 vs 3, Group 2 vs 3, (n=40) (n=40) (n=40) P for change from baseline P for change from baseline Amount of sugar added per cup tea or coffee, teaspoons, mean ± SD   Baseline 2.65±0.77 2.45±0.81 2.48±0.72   At 12 months 2.08±0.83** 1.95±0.64** 2.47±0.69 <0.01 <0.01 Pts avoiding sugar-sweetened beverages, %   Baseline 37.50 32.50 25.00   At 12 months 92.50** 90.00** 13.16 <0.01 <0.01 Pts restricting pastry to no more than 1–2 times a week, %   Baseline 37.5% 47.5% 57.5   At 12 months 70.0%** 72.5%** 39.47 <0.01 <0.05 **p<0.01 vs baseline within group.

Conclusion

Pre-discharge preventive counselling with subsequent remote support in coronary patients with abdominal obesity resulted in significant improvement of dietary habits in terms of added sugar, sugar-sweetened beverages and pastry intake.

[Psychosocial Risk Factors in Patients With Most Common Cardiovascular Diseases Such as Hypertension and Coronary Artery Disease (Based on Results From the Russian Multicenter COMET Study)]

BACKGROUND

Psychosocial risk factors (RFs) play a major role in the development and progression of cardiovascular diseases (CVDs).

AIM

The COMET study aimed to obtain current data on psychosocial RFs in outpatients with arterial hypertension (AH) and/or coronary heart disease (CHD) seen in primary care facilities in 30 cities of Russia.

METHODS

In 2016-2017, a multicenter cross-sectional study was carried out involving 325 physicians from community primary care facilities who enrolled 2,775 patients with AH and/or CHD ≥ 55 years of age. However, only 73 CHD patients (2.6%) were not hypertensive, therefore, these patients were excluded from the analyses. As a result, current paper is based on the comparison of AH patients (n=1687) vs. participants with both CHD and AH (AH+CHD; n=1015). We collected patients' socio-demographic data, clinical features, traditional and psychosocial RFs, such as anxiety and depression, stress level, type D personality, and treatment adherence.

RESULTS

The study population (women, 72%; mean age ± SD, 66.7 ± 7.9 years) had a significant prevalence of psychosocial RF. 43.8% of AH patients and 45.5 % of participants with AH+CHD rated their income as low or very low, a low educational level was reported in 21.6% and 26.0%, respectively (both p=n/s). Social isolation was uncommon, but it occurred more frequently in AH+CHD patients (8.3% vs. 5.2%, p&lt;0.01). Nevertheless, 40.2% of AH patients and 39.4% of AH+CHD were not married, and 26.0% and 24.6% were living alone, respectively. Elevated stress level was prevalent in more than 60% of patients (67.9% in AH patients vs. 67.7% in AH+CHD patents, p=n/s), and 63.3% and 64.8% of patients, respectively, reported stressful life events in the preceding year (p=n/s). Type D personality was more common in AH+CHD patients (41.2% vs. 35.8%; p&lt;0.01). Clinically significant anxiety symptoms were prevalent in 24.7% ofAH patients and in 27.4% ofAH+CHD patients (p=n/s), and clinically significant depressive symptoms were identified in 13.9% and 20.9%, respectively (p&lt;0.001).

CONCLUSION

We obtained current data on psychosocial RFs prevalence in outpatients with the most common CVDs in primary care setting. At the moment, their prevalence remains significant.

[Medical awareness of risk factors of cardiovascular diseases in different types of hospitalized patients (part 2)]

OBJECTIVE

To study medical awareness of cardiovascular risk factors (RFs) in different types of hospitalized patients (pts).

METHODS

A total of 150 pts from neurological, endocrinological and cardiac units one of Moscow city hospital were enrolled into the survey (50 pts in each unit). The pts were interviewed during the I-II days of the hospitalization. A special questionnaire was developed in‑ cluding socio-demographic and clinical indicators, open questions on the awareness of traditional cardiovascular RFs and their target values.

RESULTS

Pts of three units did not differ in gender and age. The range of diagnoses corresponded to the profile of the unit. The survey revealed an extremely low awareness of major cardiovascular RFs of pts in all 3 units: almost none of them pointed to elevated cholesterol (0%, 4% and 0%, respectively) and blood pressure (2%, 2% and 0%) respectively) as RF of cardiovascular diseases. The pts of the three units most often referred to stress (64%, 56% and 66%, respectively) and unhealthy diet (50%, 56% and 64%, respectively) as the main cardiovascular RFs. On average, pts in three units correctly indicated only 2 RFs.

CONCLUSION

The survey revealed a low awareness of cardiovascular RFs in different types of medical pts, including cardiac pts, at time of hospital admission.

[Efficiency of primary prevention for diseases caused by atherosclerosis in patients at high cardiovascular risk in Russia and other European countries (Part 2)]

BACKGROUND

The picture of primary prevention obtained from real-life practice makes possible scheduling measures for prevention improvement.

AIM

To analyze features of drug and non-drug therapy aimed at decreasing cardiovascular risk in Russian patients with a high risk (HR) of CVD compared with the study general population.

MATERIALS AND METHODS

14 European countries, including the Russian Federation, participated in this cross-sectional study. The study included patients aged 18-80 without clinical signs of atherosclerosis who have received antihypertensive and/or lipid-lowering therapy and/or therapy for diabetes mellitus (DM) within >6 to.

[Efficacy of primary prevention for atherosclerosis-induced diseases in patients with high cardiovascular risk in Russia and other European countries (Part 1)]

RELEVANCE

Evaluation of the effectiveness of risk management in persons with high cardiovascular risk is an important element in reducing the death rate of the population from cardiovascular diseases (CVD).

AIM

Analysis of the prevalence and level of risk factors control in patients with high CV risk CVD from the Russian centers of the primary care unit of the EUROASPIRE IV study in comparison with the general population of the study.

MATERIALS AND METHODS

In this cross-sectional study, 14 European countries, including the Russian Federation, participated. Patients aged 18 to 79 years were included in the study, without clinical manifestations of atherosclerosis, who were prescribed antihypertensive therapy and/or lipid lowering therapy and/or treatment for diabetes between the ages of ≥6 months and.

Psychosocial Risk Factors in Ambulatory Patients With Arterial Hypertension and Ischemic Heart Disease of 30 Cities in Russia: Data from the КОМЕТА (Сomet) Study

BACKGROUND

Psychosocial (PS) risk factors (RF) make a substantial contribution in populational burden of cardio-vascular diseases (CVD) and their complications.

PURPOSE

The KOMETA (Comet) study was directed to obtaining actual information on PSRF among ambulatory patients with arterial hypertension (AH) and / or ischemic heart disease (IHD) in 30 cities of Russian Federation.

MATERIALS AND METHODS

This multicenter cross-sectional study was conducted in 2016-2017. Doctors participating in the study (n=325) recruited in state polyclinics 2775 patients aged ≥55 years with AH and / or IHD. Information collected from these patients comprised social-demographic and clinical characteristics, data on RF, adherence to therapy. Assessment of PSRF was carried out with consideration of levels of anxiety, depression and stress, presence of personality type D.

RESULTS

Population of patients studied (72 % women) was characterized by considerable prevalence of PSRFs. Low levels of education and income were found in 24.5 and 44.2 % of patients, respectively; 25.2 % of patients reported living alone, 6.3 % - felt social isolation. Elevated, extremely high levels of stress, type D personality were detected in 67.8, 10, and 37.6 % of patients, respectively; clinically significant symptoms of anxiety and depression were found in 25.5 and 16.3 %, respectively. Most RFs were significantly more often detected in women, and older people. One third of patients (33.1 %) during a year preceding inclusion took some psychotropic drugs mainly herbal or barbiturate-containing (27.1 %). Moreover, 30 % of patients had lowering of cognitive functioning.

CONCLUSION

In this large-scale study we revealed high prevalence of PSRFs among ambulatory patients with AH and / or IHD in Russia. Despite positive dynamics of prevalence of states of anxiety and depression relative to earlier studies in this country their negative impact on prognosis of CVD and quality of life of affected patients requires optimization of efforts for organization of adequate care and directed to timely diagnosis and correction of these states.

[The New European Questionnaire for Assessment of Quality of Life of Patients With Ischemic Heart Disease: HeartQoL]

Quality of life (QL) of patients with ischemic heart disease (IHD) is a combination symptoms of the disease, physical state, emotional status, and social-laboring functioning. Until recently there were no universal questionnaire allowing to perform comparative analysis of QL of patients with effort angina (EF), survivors of myocardial infarction (MI) and chronic heart failure (CHF). Therefore, European Association of Cardiovascular Prevention and Rehabilitation conducted a study with the aim of developing universal questionnaire for assessment of QL in patients with IHD - HeartQol. The study enrolled 6384 patients with angina, MI, or CHF across 22 countries (315 in Russia). Patients completed a battery of questionnaires and Mokken scaling analysis was used to identify most important guestions for assessment of QL questions to be included into the HeartQoL questionnaire.

[First Results of Analysis of the Russian Part of the European Register on Cardiac Rehabilitation EuroCaReD (European Cardiac Rehabilitation Database)]

The joint European Registry of patients with cardiovascular diseases participating in cardiac rehabilitation programs (European Cardiac Rehabilitation Database, EuroCaReD) is conducted in collaboration between the ESC and EACPR). Its main goals were to improve the routine use of cardiac rehabilitation, to develop joint standards for cardiac rehabilitation in all European countries and evidence based rehabilitation programs and to monitor any changes. In the EuroCaReD registry participated a total of 44 centers from 13 countries, including 3 centers from Russia, which enrolled 151 patients during 2010-2012. This paper is comparing the baseline demographics, clinical data and risk factors in Russian patients versus the rest of Europe. It was shown that cardiac rehabilitation patients in Russia, as in the whole cohort, are predominantly male. Elderly patients from Russia were 3 times less likely to be referred for rehabilitation than in Europe. Unlike the whole cohort Russian patients were almost never sent to rehabilitation because of heart failure or stable angina. Likewise the whole Europe Russian patients had an average of 3 cardiovascular risk factors before rehabilitation, but with some national differences in their prevalence and severity.

Mean-field treatment of polarons in strong electrolytes

Using variational estimates for the grand partition function, we have developed a microscopic theory of an excess electron in an ionic liquid at high ion concentrations. We have derived the free-energy functional for the electron and have calculated electron energies for the ground and the first excited states as well as electron-ion correlation functions versus thermodynamic parameters of liquid and parameters of electron-ion potentials. We have found that the energetic characteristics of solvated electron are mainly determined by the Coulomb interaction which gives birth to polaronlike states, while ion cores have a pronounced quantitative effect on these characteristics. The local solvent structure around the excess electron is determined by the mean field induced by ions. Using the method developed we have calculated polaron characteristics in molten salts, such as the maximum of the absorption spectrum and its variations caused by changes in temperature, density, and composition of the electrolyte. The data obtained are in agreement with experiments and computer simulations.