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Purpose of the study: to study the reasons for seeking outpatient medical care for patients in whom, after death, the code R-54 (old age) is indicated in the medical death certificate (MCD) as the initial cause of death (PPD).Materials and methods of research. Data from the electronic database of the Main Department of the Civil Registry Office of the Moscow Region (USR registry office system of the Moscow Region) and electronic medical records (EMC) from outpatient clinics of the Moscow Region for 2020–2021. In total, 1,269 cases were registered in the MSS with the code R-54 (old age) indicated in the MCD as a PPD, of which 987 (77.7 %) sought outpatient medical care. Data included gender, age, 4-digit ICD codes for all reasons for referrals.Results. The mean age of the deceased was 87.7 ± 4.7 years (minimum 76 years, maximum 103 years; 1.4 % under the age of 80; females 88.08 ± 4.7; males 86.59 ± 4.6 p < 0.001). In 4 of the deceased, IHD was indicated as other causes contributing to death (part II of the MCD). On average, there were 3.77 ± 3.98 (men 4.2 ± 3.6 and women 3.6 ± 3.3; p = 0.04) reasons for visiting, indicated by 4-digit ICD codes. IHD group codes were registered in 21 %; AG 38.5 %; codes of the group “cerebrovascular diseases” – 25.3 %; cancer – 6.8 %; 5.1 % diabetes mellitus; 9.8 % – COVID-19. Among those who registered one reason for contacting (25 % – 1 4-digit ICD-10 code), 70 % applied for diseases, the rest of the reasons for contacting belonged to the codes of groups R, S and Z.Conclusion. In the overwhelming majority of cases, the R-54 code in the MCD is used unreasonably. However, taking into account the position of the WHO set out in the ICD and data from other countries, it is necessary to clarify the criteria for the use of both this code and other vaguely defined terms and codes that are used in the MCD as PPD.

A significant number of studies on chronic heart failure (CHF) are published worldwide. However, the issue of uniform criteria and approaches to accounting for ambulatory care and mortality associated with this pathology in patient accounting systems has remained resolved, meaning the data and indicators obtained in different regions and countries are not comparable. The aim of the article is to substantiate the need for discussion in the Russian Society of Cardiology on the possibility, principles and methodology of uniform accounting of ambulatory care, hospitalizations and deaths associated with chronic heart failure in healthcare using the classifications of heart failure applied in clinical practice.

The aim. Analysis of data from medical certifi cates of death, in which the diagnosis of new coronavirus infection (COVID-19) is indicated as the primary cause of death or the contributing cause factor of death.Material and methods. The study was carried out on the basis of the electronic database of the Main Directorate of the Civil Registry Office of the Moscow Region, based on medical death certificates for 2020. All cases (13,356), in which the diagnosis of COVID-19 is indicated as the primary cause of death or the contributing cause factor of death, were selected. The analysis included deaths registered in the hospital (12,960). 3 groups were formed: group 1 — deaths from COVID 19, without concomitant pathology — 5620 (43.4%), group 2 — deaths from COVID-19 with concomitant pathology — 5706 (44%), and group 3, in which COVID-19 was indicated as the contributing cause factor of death — 1634 (12.6%).Results. In addition to COVID-19, 100% of deaths were caused by pneumonia. At the age group of up to 30 years, the number of deaths was 0.4%, among people of 31–50 years old — 6.6%, 51–70 years old — 36.9%, and over the age of 70 years old — 56.1%. In the group of those who died from COVID-19 (group 2), coronary heart disease (CHD) and/or arterial hypertension (AH), diabetes mellitus and obesity were registered more often than in the group of those who died from other primary cause (group 3). Oncopathology, miocardial infarction (MI), acute cerebrovascular accident (ACV), bleeding, HIV were registered less often. There were no diff erences in the incidence of thrombosis (6.4% and 5.7%) and COPD (2.4% and 2.9%) in the 2nd and 3rd groups. As the primary cause of death, acute respiratory failure or acute respiratory distress syndrome was indicated most often — 77.3% (93.4% — in the 1st group, 76.6% — in the 2nd and 10.0% — in the 3rd), cardiopulmonary ineffi ciency — 12.3% (5.6%, 18.3% and 15.9% in groups 1–3, respectively), wet brain — 5.2% (0.4%, 3.3% and 33.6% in groups 1–3, respectively).Conclusions. 43% of medical certifi cates of death did not list other diseases/conditions except COVID-19 and pneumonia. In other cases the analysis did not allow to determine whether COVID-19 had been the main cause of death and the contributing cause factor of death in the absence of clear criteria. More than 90% of deaths were registered in people over 50.

Aim. To study the dynamics of the number of coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI) in some countries and Russia in the 2000–2018..Methods. The data of the official statistics of the Organization for Economic Cooperation and Development on the number of CABG and PCI were used. The countries that have provided data for most of the analyzed years and have more than 30 CABG per 100,000 population (22 countries) were selected. Data on the number of interventions in Russia were obtained from the CNIIOiIZ and Bakulev NMICSSH. The US data are obtained from the literature.Results. In most countries, the number of CABG decreased by 2018.The United States, Denmark, Finland, Israel, and Luxembourg were the most variable in the average indicator. The most expressed decrease occurred in Finland (2.9 times). The number of PCI has increased significantly (in 9 countries by more than 2 times). The exception was the United States, where the number of PCI decreased by 2 times from 2003 to 2016. In Russia, there was an increase in CABG and PCI (by 10.2 and 50.5 times, respectively). The number of CABG and PCI per 100,000 population was 23 and 34 times less, respectively, in Russia than the international average in 2000, and 1.4 and 1.55 times less in 2018. The decrease in CABG is due to the improvement of PCI technologies, as well as the improvement of pharmaceutical treatment of coronary vessels. The number of proceedings, including court ones, on the validity of stent implantation is growing. The crosscountry variability of the use of cardiac surgical methods is influenced by the organizational and financial characteristics of the healthcare system, demographic and clinical characteristics of patients, the knowledge of doctors, etc. The experience of Russia fully confirms this.Conclusion. There is no optimal method for accurately assessing the population's need for certain treatment methods. Each country chooses its own tactics, taking into account its resource capabilities, approaches to decision-making, its values and preferences, but the general trend is a decrease in the number of CABG operations while increasing the PCI. In Russia, there is a multiple increase in the number of CABG and PCI, but it is less than the indicators of most countries.

Aim. To evaluate the detection rate of carotid artery stenosis (CAS) based on the diagnosis code according to the International Clas­sification of Diseases of 10th revision (ICD-10), used in appointment card for carotid duplex ultrasound.Material and methods. To conduct this study, the Duplex-2013 registry database was used, which sequentially included 2548 patients. When referring to carotid duplex ultrasound, all patients indicated the ICD-10 diagnosis code as the main reason for seeking medical help. The study assessed the presence and severity of CAS, the probability of CAS, taking into account age, sex, and referral diagnosis according to ICD-10.Results. According to the results of a univariate analysis, the following referral diagnoses were associated with the identification of CAS by two criteria (stenosis ≥20 and ≥50%): generalized/peripheral atherosclerosis (GPA) — odds ratio (OR), 6,54; 95% confidence interval (CI): 2,71-18,89 (p20%) is associated with HTN — OR, 1,43; 95% CI: 1,19-1,71 (p50% — acute myocardial infarction — OR, 8,45; 95% CI: 1,32-53,97 (p=0,02) and GPA — OR, 9,82; 95% CI: 4,81-20,04 (pConclusion. Certain groups of referral diagnoses (ICD-10 codes) are associated with a higher probability of CAS. The obtained data needs to be refined in order to optimize routing and referral for carotid duplex ultrasound.

Rationale: Cardiovascular disorders play a leading role in populational mortality, but they are not synonymous to cardiac pathology. The city of Moscow and the Moscow Region are one of the biggest urban agglomeration worldwide.Aim: Analysis of cardiac-related mortality in Moscow and the Moscow Region.Materials and methods: We calculated standardized mortality coefficients (SMC) for 23 death causes given as separate lines in the Short List of Death Causes by the Russian Agency of Statistics (Rosstat) in 2019.Results: In 2019, SMC for cardiac causes was 171.2 per 100 000 of the population in Moscow (27.6% of all causes) and 248.7 per 100 000 of the population in the Moscow Region (26.9% of all causes). More than 60% of deaths both in Moscow and in the Moscow Region were caused by chronic variants of ischemic heart diseases, whose criteria are not well-defined or are absent. In Moscow, SMC for myocardial infarction is significantly lower, whereas that for unspecified cardiomyopathy (the code by International Classification of Diseases and Health-related Conditions, version 10 (ICD10) I42.9) is higher. SMC from the groups of death causes related to chronic illness possibly unrelated to atherosclerosis, are comparable: 29.64 in Moscow and 24.59 in the Moscow Region. SMC from arterial hypertension (ICD10 I10-13) are 8.7 and 5.6 per 100000 of the population, respectively.Conclusion: Despite higher total cardiac mortality in the Moscow Region, SMCs for individual death causes in Moscow are significantly higher. SMC variability is mostly related to different algorithms for determination of primary death cause. ICD10 and the Rosstat the Short List of Death Causes seem to be suboptimal sources to understand the contribution of cardiac causes into the mortality structure. Any correct comparison would become possible after a consensus of expert positions by specialists in Moscow and Moscow Region on the criteria of diagnosis, choice of primary death cause and corresponding disease code.

The review article presents data on: a) definition of microhematuria and diagnosis; b) prevalence estimation and causes of the asymptomatic microscopic hematuria; c) diagnostic approaches for the first time identified of microhematuria; d) follow-up monitoring of patients with asymptomatic hematuria; e) feasibility of medical screening for microhematuria. The analysis includes recommendations of Russian and foreign urological associations, the results of cohort and observational studies, previous study reviews. The identification of 3 or more red blood cells during microscopic examination should be considered microhematuria. There is no uniform examination algorithm for all patients. The basic principle is an individual diagnostic tactic, taking into account the anamnesis, age, concomitant diseases and risk factors. The purpose of a comprehensive examination is to exclude life-threatening conditions (malignant neoplasms and/or glomerular kidney damage). In some cases, after research, the cause of microhematuria remains unclear and monitoring is required. Routine screening of the population in order to detect microhematuria is currently not justified.В обзорной статье представлены данные по вопросам: а) определения понятия микрогематурия и методов ее выявления; б) оценки распространенности и причин бессимптомной микрогематурии; в) диагностических подходов при первичном (случайном) выявлении микрогематурии; г) последующего мониторинга пациентов с бессимптомной гематурией; д) целесообразности скрининга на микрогематурию. В анализ включены российские и зарубежные рекомендации профессиональных сообществ, результаты когортных и обсервационных исследований, ранее выполненные обзоры. Микрогематурией следует считать выявление 3 и более эритроцитов при микроскопическом исследовании. В мире отсутствует единый для всех пациентов алгоритм обследования. Основной принцип индивидуальная диагностическая тактика с учетом анамнеза, возраста, сопутствующих заболеваний и факторов риска. Целью комплексного обследования является исключение жизнеугрожающих состояний (злокачественного новообразования и/или гломерулярного поражения почек). В части случаев после проведения исследований причина микрогематурии остается неясной и требуется мониторинг. Рутинный скрининг населения с целью выявления микрогематурии в настоящее время не считается обоснованным.

Aim. To analyze mortality from cardiovascular diseases (CVDs) and diseases associated with cognitive impairment (CI) in the regions of the Russian Federation.Material and methods. We analyzed Rosstat mortality data in 82 Russian regions in mid-year population in one-year age groups for 2019-2021. Eleven groups of causes have been formed, standardized mortality rates (SMRs), average regional SMRs, and their changes over time was assessed.Results. In total, SMRs from CVD and CI increased from 551,4±84,9 in 2019 to 622,6±98,5 per 100 thousand population in 2020 and decreased in 2021 to 612,6±106 per 100 thousand population. However, its proportion in all-cause mortality decreased by almost 10% (46,97±4,6 in 2021 and 55,98±4,6% in 2019). The growth of SMRs from year to year was noted in 30 regions; in other regions, unstable changes were noted. The proportion of CVD causes from all-cause mortality was 30,5±5,8% in 2019, 29,1±5,7% in 2020 and 25,95±5,56% in 2021 (pConclusion. When developing and implementing programs aimed at reducing mortality, results obtained should be taken into account. Significant regional differences in the rate and changes of SMRs over time indicate the need to unify the criteria for the underlying cause of death, especially in multimorbid patients.

Significant differences in mortality rates of the most of the death causes were detected between Moscow and Saint-Petersburg in the number of researches. Aim.Comparison and ranging of standardized mortality rates (SMR) from malignant neoplasms (MN) of different localizations in Moscow and in Saint-Petersburg in 2015 and 2018; determination of the localizations with main input in SMR from MN. Materials.Number of citizens and number of deaths from tumors accordingly to Rosstat Short nomenclature of the death reasons were evaluated. Death rates were calculated using the special computer programs on the base of European standard, comparison was provided with help of non-parametric criteria. Results.SMR of 29 from 33 MN localizations became lower in 2018 comparing to 2015 both in Moscow and in Saint-Petersburg. The average SMR decreased in 2018 in Saint-Petersburg statistically significant (p=0.003) and in Moscow non-significant (p=0.34). The largest SMR value both in 2015 and in 2018 in Moscow and in Saint-Petersburg as well were registered from 7 cancer localizations (trachea, bronchus, lungs; large intestine; breast; pancreas; rectum; prostate). The share of these SMR localizations in all MN was 57% and 54% in Moscow and 57 and 56% in Saint-Petersburg correspondingly. SMR of all 7 localizations were lower in Moscow comparing to Saint-Petersburg. SMR was lower in 2018 comparing to 2015 in both cities. The share of MN of others, unspecified, non-classified, etc. localizations in all MN was 11% in 2015 in both cities. Its share was in 2018 13.5% in Moscow and 10.1% in Saint Petersburg. Conclusions.SMR of most MN was higher in Saint Petersburg as in Moscow both in 2015 and in 2018. The analyses of the effectiveness of screening programs and of health care organization for patients with MN with highest SMR is needed. The questions of the differential diagnostics (intravital and postmortem) and of control the quality of medical death certificates filling in should be solved for the decrease of mortality of nonrefinement MN.

The increase in life expectancy of the population, the more frequent occurrence of heart failure (HF) among the elderly and the increasing costs of its treatment are a significant economic burden for the health of any country. The reasons for the hospitalization of patients with chronic HF (CHF) can be either a worsening condition of the underlying disease, which was complicated by HF, decompensation of HF, the need for implantation of resynchronizing pacemakers and other devices, or heart transplantation. Different reasons for hospitalization require different resources. CHF should be taken into account (coded) as the main final diagnosis in those cases when it is the main reason for hospitalization and the greatest expenses for providing medical care. To plan the volumes and analyze the results of inpatient care for patients with HF, it is necessary to make appropriate additions to the state statistical monitoring forms and to the instructions of the Federal Compulsory Medical Insurance Fund to classify cases of medical care as a specific clinical and statistical group.

Currently, with osteoarthritis (OA), numerous over-the-counter and prescription drugs are used, as well as biologically active additives (BAA). Significant market share in Russia are: chondroitin sulfate, glycosaminoglycan-peptide complex and Alflutop. The purpose of the article is to compare the clinical recommendations of the professional communities of doctors of the Russian Federation, countries of Europe, Great Britain, the USA, Canada, Australia on approaches to chondroprotective therapy/SYSADOA for osteoarthritis using the example of chondroitin sulfate, glycosamine glycan-peptide complex and Alflutop. Materials and methods : The analysis included 11 clinical recommendations (guideline) from 2008 to 2019 on the management of patients with OA. Results : The glycosaminoglycan-peptide complex (Rumalon) and Alflutop were recommended by the Russian Scientific Medical Society of Therapists (RNMOT), but are not mentioned in the recommendations of several Russian professional communities. In the European recommendations, the glycosaminoglycan-peptide complex and the drug Alflutop are not considered. Chondroitin sulfate to reduce the symptoms of OA is recommended by 5 professional guideline. With the exception of Russian recommendations, the listed professional communities recommend the use of chondroitin sulfate only as a “pharmaceutical quality drug”. Conclusion : It is advisable to agree on Russian recommendations on the use of the drugs in question. At the level of foreign and Russian professional communities, particular attention is required to analysis of data on the use of chondroitin sulfate, taking into account the quality of production, the composition of active substances and bioavailability, the quantitative content of active substances and the quality of substances. It is necessary to systematize the products with a separate assessment of the effectiveness of registered medicines, biologically active additives of pharmaceutical quality and low-quality products with minimal bioavailability.

Aim. To analyze the contribution of cardiac causes to all-cause mortality, to characterize the differences in standardized mortality rates (SMRs) in Russian regions, as well as to identify promising directions for improving establishment of cardiovascular death and its coding.Material and methods. We used the Federal State Statistics Service (Rosstat) data on the mortality rate and the average annual population in one-year age groups for 2019. To calculate the SMR, the European Standard Population was used. For each cardiac death, the SMR from 23 causes was calculated, which were combined into 4 groups, and for each of these groups, the regional mean and standard deviation of SMR in Russian regions were estimated.Results. In 2019, the cardiac SMR in Russian regions was 301,02±77,67, which corresponded to 30,5±5,8% of all death causes. At the same time, the coefficient of variation of regional cardiac SMR was 25,8%. In general, in 60,9±13,8% of cases, the cause of cardiac death was chronic diseases, mainly related to atherosclerosis. The proportion of deaths from acute types of coronary artery disease was 17,3±9,7%, deaths not associated with atherosclerosis (heart defects, myocardial diseases, etc.) — 17,5±8,2%, deaths associated with hypertension — 4,2±5,2%. The coefficient of variation of regional SMR was 34,66, 64,47, 50,99 and 122,7, respectively.Conclusion. Significant regional differences in SMR from certain cardiac causes and groups of causes, as well as their contribution to mortality pattern, were revealed. It is necessary to continue the research on the methodology of statistical recording of certain cardiovascular diseases.

The purpose of the study is to analyze the application of I50.9 code as initial cause of death (PBC) in various subjects of the Russian Federation in 2013-2019. The Rosstat data (Annual forms C41 and C51) based on the "Brief Nomenclature of Causes of Death of Rosstat" (KNPSR) in 2013-2019. The standardized mortality rates (SPS) were determined using corresponding software (state registration number 216661114), coefficient of variation (Cv) and the max/min ratio. In 2013-2019, the regional average value of the SCR from cardiac failure (code I50.9) decreased up to 4 times (from 6.3 ± 10.3 to 1.5 ± 3.5; p0.0001), but Сv of regional SCR increased by almost 1.5 times (162% and 230%). The percentage of regions where cardiac failure was not indicated as PPP, increased from 8% in 2013 to 19% in 2019. However, only in the Yaroslavl Oblast and the Republic of Buryatia no case of indicating I50.9 code as PPP was registered. In five regions, less than 10 cases were registered in 7 years, in 3 regions an unstable tendency to increase in SDR from HF was established. In 36 regions, more significant variability of RMS from year to year was recorded. From our point of view, the indices are affected in parallel by teo processes: changes in mortality rates associated with chronic heart failure and changes in mortality rates due to approaches to filling out the MSS and coding PPP. To determine the contribution of cardiac failure into population mortality, it is necessary to separate concepts "chronic cardiac failure syndrome" and "cardiac failure as death mechanism" and to introduce uniform rules of indicating chronic cardiac failure syndrome in the MSS.

Aim: to analyze the quality of completion medical certificates of death (MCD) of residents of the Tula region, in which in 2017 acute and subsequent myocardial infarction (MI) was listed as the underlying cause of death (UCD) or as multiple causes of death (MC).Materials and methods. From the electronic database (DB) of MCD of residents of Tula region for 2017 we selected all MSD in which MI was written down irrespective of a section of MCD. A total of 689 MSD (43.8% men and 56.2% women) were analyzed.Results. Mean age of the deceased was 72.6±11.3 years (men 67.25±0.62; women 76.7±9.8; pConclusion. Mortality analysis using solely UCD leads to decreasing mortality rates from MI, and unsatisfactory quality of filling the MCD decreases the ability to identify MC, that prevents the correction of priorities in the organization of medical care. The revealed problems of coding causes of death require urgent solutions from the professional community of cardiologists, pathologists, and the Ministry of Health.

The differences in mortality rates between Moscow and St. Petersburg require study. Aim . Ranking and comparison of cardiovascular mortality in Moscow and St. Petersburg in 2015 and 2018. Material and methods . Data on the population and mortality rates was assessed according to the Brief nomenclature of causes of death of Federal State Statistic Service. Eleven out of 35 nomenclature lines related to cardiovascular disease (CVD) are represented by 4-digit ICD codes, the rest are represented by groups with 3- and/or 4-digit codes. Standardized mortality rates (SMRs) were calculated based on the European standard. Comparison of SMR differences between Moscow and St. Petersburg in 2015 and 2018 was carried out using the nonparametric Wilcoxon test. Results . The proportion of CVD in all-cause SMR in both cities is about 50%. There were no significant differences in SMR (2018-2015) between Moscow and St. Petersburg for 35 CVDs. The first 3 ranking places in the CVD pattern both in Moscow and St. Petersburg were occupied by CAD, different types of chronic CAD, and stroke. In 2015, their proportion was 58,3% and 48,9% and in 2018, 52,7% and 58,7%. Other causes varied significantly in relation to SMR and ranks in different years, which is probably due to different approaches to determining the code of death cause. The SMR and myocardial infarction contribution to cardiovascular mortality decreased. Conclusion. Differences in cardiovascular mortality between Moscow and St. Petersburg remain. To understand the mortality causes and to develop effective programs to reduce it, it is necessary to eliminate the identified defects.

Mortality rates have significant differences between regions of the Russian Federation. Standardized mortality rates (SMR) are influenced by many factors, including diagnosis criteria and causes of death.Analysis of coefficient of variation of SMR from malignant neoplasms compared with other causes of death in the subjects of Russian Federation.The study formed 3 comparison groups: malignant neoplasms, other causes and causes of death, presented in ICD-10 to indicate conditions that do not have clear diagnostic criteria and rules for its use, as well as unspecified and not recommended for use in mortality statistics. To calculate SMR out of 79 reasons selected from the «Brief nomenclature of causes of death of Russian Statistic Bureau (RosStat)», the European standard was used. The accuracy of differences between the groups was evaluated using one-way analysis of variance with pairwise comparison and Bonferroni correction.In the group of malignant neoplasms, there were significant differences in the coefficients of SMR variability between the subgroup of neoplasms with an exact indication of localization and the subgroup of malignant neoplasms of other and inaccurately defined localizations. However, even the causes of death from malignant neoplasms that do not have sufficiently clear application criteria have a significantly less pronounced coefficient of SMR variability compared to the other two groups. The causes of death, starting in the RosStat nomenclature with the words «other diseases», and the causes associated with the diseases presented in ICD-10 to indicate conditions that do not have clear diagnostic criteria and rules of its use, as well as unspecified and not recommended for use, had practically the same high level of SMR variability coefficient. A certain contribution to the differences in regional SMR indicators from specific causes can be affected by the inconsistency of the criteria for diagnosing diseases and choosing the initial cause of death.To obtain the correct indicators of mortality from individual causes / groups of causes, we need unified generally accepted definitions and rules for the application of conditions presented in ICD-10, which do not have clear diagnostic criteria, as well as unspecified; and as well as rejection of statistics not recommended for use because of the initial causes of mortality.Показатели смертности населения имеют существенные различия между регионами Российской Федерации. На стандартизованные коэффициенты смертности (СКС) влияют многие факторы, включая критерии установления диагноза и причины смерти.Анализ коэффициента вариации СКС от злокачественных новообразований по сравнению с другими причинами смерти в субъектах РФ.В исследовании сформированы 3 группы сравнения: злокачественные новообразования, другие/прочие причины и причины смерти, представленные в МКБ-10 для обозначения состояний, не имеющих четких критериев диагностики и правил применения, а также неуточненных и не рекомендованных к применению в статистике смертности. Для расчета СКС от 79 причин, отобранных из «Краткой номенклатуры причин смерти Росстата», использовали Европейский стандарт. Достоверность различий между группами оценивали с помощью однофакторного дисперсионного анализа с попарным сравнением и поправкой Бонферрони.В группе злокачественных новообразований имелись достоверные различия коэффициентов вариабельности СКС между подгруппой новообразований с точным указанием локализации и подгруппой злокачественных новообразований других и неточно обозначенных локализаций. Однако даже причины смерти от злокачественных новообразований, не имеющих достаточно четких критериев применения, имеют значительно менее выраженный коэффициент вариабельности СКС по сравнению с двумя другими группами. Причины смерти, начинающиеся по номенклатуре Росстата со слов «другие заболевания», и причины, связанные с заболеваниями, представленными в МКБ-10 для обозначения состояний, не имеющих четких критериев диагностики и правил применения, а также неуточненных и не рекомендованных к применению, имели практически одинаковый высокий уровень коэффициента вариабельности СКС. Определенный вклад в различия региональных показателей СКС от конкретных причин может влиять несогласованность критериев диагностики заболеваний и выбора первоначальной причины смерти.Для получения корректных показателей смертности населения от отдельных причин/групп причин требуются единые общепринятые дефиниции и правила применения в качестве первоначальных причин смерти, представленных в МКБ-10 состояний, не имеющих четких критериев диагностики, а также неуточненных, и отказ от нерекомендованных к применению в статистике смертности.

For organization of health care, it is important to know the requirement for its individual types, including the number of hospitalizations and the use of expensive technologies. Heart failure (HF) syndrome in patients with cardiovascular diseases often determines their severity and prognosis. However, being a complication of underlying disease, HF is not included into statistical reports and medical bills in the compulsory health insurance system. This article focuses on issues in evaluating HF prevalence and mortality in different countries and provides the authors’ consensus on approaches to HF coding in the informational systems, which record morbidity and mortality.

The standardized mortality coefficients for different causes have significant variability between regions and depend on many factors. The purpose of study was to investigate interregional variation coefficients of standardized mortality of oncologic diseases as compared with other causes having no explicit diagnosis criteria. The 49 death causes were selected out of 295 causes of the Short nomenclature of the Rosstat. These causes were distributed by 2 groups: neoplasms and causes without explicit diagnostic criteria. The standard mortality indicator was calculated on the basis of the European standard. The significance of differentiations between the groups was estimated using one-factor dispersion analysis by pair comparison and Bonferroni amendment. The level of interregional variation coefficient of the standard mortality indicator from cancer was lower than from other causes with no explicit diagnostic criteria. Even the reasons of death from oncologic diseases which has no explicit criteria have the significantly less marked variation coefficient as compared to other two groups. There were reliable differences of the variation coefficients between the subgroup of oncologic diseases with precise location of tumor and the subgroup of oncologic diseases of other and non-explicit locations. The death causes due to "other diseases" and the death causes due to diseases with no-explicit diagnostic criteria had similarly high level of variation coefficient. The difference of the regional standard mortality indicator of concrete reasons is affected by uncoordinated criteria of diseases diagnostic and the main reason of death determination. The letter of the Minzdrav of Russia concerning the rules of application of notion "senility" as cause of death played certain role also. The different level of morbidity in regions had the influence as well. The harmonization of verification of all the cases of diagnosis, its "depth" and applied criteria is needed for proper analysis of data of death from separate causes is needed.

The purpose of the present review is to bring into focus the issues regarding terminological and registration aspects of multimorbidity we come across in the modern literature. Key questions regarding the definitions for the most widely used terms «comorbidity», «polymorbidity» and «multimorbidity» are discussed. We also considered the aspects of their origin and distinctive features between the concepts. The interaction between illnesses can exacerbate one another, modify the clinical picture and course of illnesses, the nature and severity of complications, lead to a progressive worsening of the prognosis and quality of life in patients. It has been proposed that the terms of “comorbidity» (in case of presence of the pathogenesis interrelation) or “polimorbidity» (in case of absence of the pathogenesis interrelation) are the most appropriate diagnostic and treatment patterns for practice and epidemiological study. «Multimorbidity» seems to be a more appropriate term for clinical practice usage, because it involves not only diagnosis but also interaction between diagnosises, symptoms/syndromes, the mobility or self-care problems et al. The algorithm of the managing patients with multimorbidity is presented.

The identification of factors that determine the structure and rate of mortality is a topical complex task requiring unification of efforts of medical science and social disciplines. The authors contribute to its solution through a comparative study of mortality indicators in two Russian megalopolises—Moscow and St. Petersburg. Analyzing statistical data, they form several hypotheses that help explain the significant differences in the mortality rates of the two cities. The focus is not only on the socioeconomic and climatic features of Moscow and St. Petersburg but also on the state of the financial and resource support of the health care systems of these cities. The results obtained are only the first step, but a necessary one, toward an adequate system of measures to decrease mortality, implying subsequent studies on the significance of each of the factors considered.

The role of heart failure (HF) in mortality rates is ambiguous, and much depends on assessment criteria and accounting potential.Aim. Using medical certificates of cause of death (MCCD), to assess rates of HF, taking into account different types of coronary artery disease (CAD), sex, age and place of death.Material and methods. Data on deceased persons for 2020 were obtained from the electronic database of the Main Department of Civil Registry Office of Moscow Oblast, using the 4-digit codes of the International Classification of Diseases, Tenth Revision (ICD-10). All deaths with CAD codes (I20-25) were selected. A total of 23193 deaths were included in the analysis. The codes and verbal descriptions of complications were assessed and 3 groups were formed: without indication of heart failure (HF), with indication of HF (without chronic HF) and CHF in MCCD. Comparison of the average age of deceased, the proportion of women and men, the detection rates of certain CAD types and the place of death was carried out. Using logistic regression, the probability of chronic HF/HF as a death cause was determined, taking into account other factors.Results. Any HF was indicated in 78,9% of the MCCD (acute CAD — 44,5%, chronic CAD — in 89,1%). Chronic HF was indicated in 27% of the MCCD (men, 30,9%; women, 22,9%; pConclusion. According to the MCCD data, chronic HF is not the dominant complication leading to death. The results obtained require clarification in studies based on primary medical documentation.

Aim. To identify regional specifics of changes in mortality rates from acute types of coronary artery disease (CAD) in 82 Russian regions for the period from 2015 to 2019.Material and methods. The study used data from the Federal State Statistics Service of Russia on mortality from acute CAD types in 82 Russian regions. Standardized death rates (SDRs) for 2015 and 2019 were estimated based on the European standard. We analyzed the SDRs of the population from acute (primary) and recurrent myocardial infarction (MI), other acute CAD types (I21-I22, I24.8 in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10)).Results. Over the period from 2015 to 2019, mortality from all acute CAD types decreased by 21%, from acute MI — by 9%, from recurrent MI — by 22%, from any MI (acute/recurrent) recurrent — by 14%, and from other CAD types — by 21%. A decrease in mortality from all acute CAD types was recorded in 69 regions, from acute MI — in 58 regions, and recurrent MI — in 62 regions. However, a simultaneous decrease in SDRs from each of the acute CAD types (acute MI, recurrent MI and other acute CAD types) for the period 2015-2019 occurred only in 29 Russian regions. An increase in mortality from all acute CAD types was noted in 14 regions and from any MI — in 21 regions. The coefficient of variation (Cv) for recurrent MI and other acute CAD types of 69% and 103%, respectively, in 2015 and its growth (up to 75% and 134%, respectively) by 2019 indicate growing problems with the coding of death causes.Conclusion. In 2019, compared to 2015, a decrease in mortality from acute CAD types was recorded in most Russian regions. The identified regional specifics require clarification of approaches to death cause coding and the introduction of additions to mortality reduction programs, taking into account the specifics of each Russian region.