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Aim. To study the long-term prognosis of patients’ life who have suffered cerebrovascular accident (CVA), and to determine the role of diabetes mellitus (DM) as a possible negative prognostic factor, according to the outpatient follow-up stage in the REGION-M registry.Material and methods. The outpatient part of the REGION-M registry included 684 patients assigned to the Moscow City Polyclinic No. 64, discharged from the hospital in the period from 01.01.2012 to 30.04.2017 with a confirmed diagnosis of CVA, of which 122 patients (17.8%) were diagnosed with DM. The polyclinic stage included three observation points: 2017, 2020, and 2022. Data on the life status of all patients were obtained by telephone survey, if it was impossible to establish contact with the patient or his relatives, a unified medical information and analytical system was used to determine the life status of patients. The study patients were observed on an outpatient basis for more than 5 years (ME 1958 (751; 2555) days), the primary endpoint was death from any cause.Results. Information about the life status was obtained for all 684 patients. By the end of the observation, 415 cohort members had died, and 269 were alive. The average age of patients with DM was significantly higher than that of patients without DM: 71.5±10.9 years vs 68.0±14.7 years (p

Aim. To evaluate 24-month outcomes after hospital treatment of patients with coronavirus disease 2019 (COVID-19) in a prospective registry.Material and methods. Two-year outcomes (2,2±0,5) after hospital treatment for COVID-19 were analyzed in 802 patients (mean age, 59,8±14,5 years, men, 51,0%). We assessed cases of death, non-fatal myocardial infarction (MI) and stroke, revascularization operations, hospitalizations, recurrent COVID-19, vaccination for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Results. During the follow-up period, 49 (5,9%) patients died, while 7 (0,8%) patients had MI, 7 (0,8%) — stroke. In addition, 222 (26,7%) patients were hospitalized, of which 26 (3,1%) for COVID-19. Recurrent COVID-19 were revealed in 146 (17,6%) patients, while 414 (49,6%) patients were vaccinated for SARS-CoV-2. The factors of age and stay in the intensive care unit were significantly associated (p1/3 of deaths recorded in the first 3 months and >2/3 during the first year. Factors associated with death were age, male sex, and intensive care unit treatment during the hospitalization. The readmission rate was associated with older age and CVDs. The risk of repeated cases of COVID-19 was one and a half times higher in the presence of CVDs, but 2 times lower in those vaccinated for SARS-CoV-2 in the post- COVID-19 period.

Aim. To study the long-term survival of patients with cerebrovascular accident, depending on sex and age.Material and methods. The outpatient part of the REGION-M registry (patients with cerebrovascular accident, hospitalized in a Moscow hospital) included 684 patients assigned to the City Polyclinic № 64 (Moscow), discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a diagnosis of stroke, which were divided into 5 age groups: group 1 — ≤50 years, n=72 (10,5%), group 2 — 51-60 years old, n=122 (17,8%), group 3 — 61-70 years old, n=156 (22,8%), group 4 — 71-80 years old, n=185 (27,0%) and group 5 — ≥81 years old, n=149 (21,8%). The survival of patients was assessed at the 2nd and 3rd stages after 4,2 (2,4-5,6) and 5,5 (2,4-7,0) years.Results. The mortality of patients in the long-term follow-up period significantly increased with age. There were following mortality rate for stages 2 and 3 stages: 18-50 years old — 8,3 and 22,2%, 51-60 years old — 18 and 36,9%, 61-70 years old — 41 and 56,4%, 71-80 years old — 54,1 and 73%, >81 years — 76,5 and 87,9% (p

Aim. To assess the survival rate of patients after cerebrovascular accident (CVA), depending on the visits to the local outpatient clinic and the type of medical supervision, and in the first year after hospital discharge.Material and methods. The outpatient part of the REGION-M registry included 684 patients assigned to the City Polyclinic № 64 of Moscow, discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a confirmed diagnosis of cerebral stroke/transient ischemic attack.Results. During the first year after the CVA, 451 (65,9%) patients visited the local clinic on their own (group 1), while 166 (24,3%) patients was consulted by house call (group 2), and 67 (9,8%) did not see the physician (group 3). Patients visited by house call were more likely to have prior coronary artery disease and stroke, and the age of men was older than in other groups. Patients who did not see a doctor were less likely to have comorbidities and disabilities, and were less likely to visit the clinic before stroke. The mortality of patients in group 3 was significantly higher throughout the entire follow-up period (55,2%, 70,1% and 77,6% at stages 1, 2 and 3 (p

Aim. To assess, based on the results of the questionnaire, patients' awareness of the presence, possible causes and health effects of overweight /obesity; to determine patients' self-assessment of their own weight, information about the methods used to treat the disease, adherence to therapy.Material and methods. The survey of patients of the outpatient registry was carried out as part of a face-to-face visit of inclusion in the observational study of EVA using a specially designed questionnaire. Out of 582 patients of the PROFILE registry who came for a visit in the period from 08.04.2019 to 24.03.2020, 295 people with a body mass index (BMI) were included in the study>25 kg/m2.Results. According to the BMI values, the patients of the study cohort were divided into 4 groups: 108 (36.6%) with pre-obesity, 124 (42.1%) with class I obesity, 42 (14.2%) with class II obesity, 21 (7.1%) with class III obesity. With an increase in the class of obesity, the number of patients who admit the presence of this pathology in self-assessment increases (p

Aim. To study the clinical and anamnestic characteristics, pharmacotherapy of cardiovascular diseases (CVD) and long-term outcomes in post-COVID-19 patients with cardiovascular multimorbidity (CVMM), enrolled in the prospective hospital registry.Material and methods. In patients with confirmed COVID-19 included in the TARGET-VIP registry, the CVMM criterion was the presence of two or more CVDs: arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF), atrial fibrillation (AF). There were 163 patients in the CVMM group and 382 – in the group without CVD. The information was obtained initially from hospital history sheet, and afterwards – from a telephone survey of patients after 30-60 days, 6 and 12 months, from electronic databases. The follow-up period was 13.0±1.5 months.Results. The age of post-COVID patients with CVMM was 73.7±9.6 years, without CVD – 49.4±12.4 years (p0.05). There were higher rate of all-cause mortality among patients with CMMM (12.9% vs 2.9%, p

Aim. To study the frequency of detection of hyperuricemia (HU) in patients with high and very high cardiovascular risk and the frequency of prescribing drugs that lower serum uric acid (sUA) levels in real clinical practice.Material and methods: The general information of the study was based on the data of 2457 patients who were consistently included in the «PROFILE» registry until November 30, 2020: 1250 men (50.9%) and 1207 (49.1%) women. All patients with HU were selected (UA level ≥360 pmol/l in women, ≥420 pmol/l in men). At the stage of inclusion of the patient, data on MC indicators were available in 1777 (72.3%), upon re-examination - only 262 (33.2%) out of 790 patients who returned to the appointment.Results: The most common study of the level of sUA was performed in patients with gout (65.2%), with arterial hypertension (AH) and dyslipemia in 29.1% of cases, with diabetes mellitus (DM) - 30.1%, with impaired tolerance to glucose (IGT) - 40.2%, with other diseases, the proportion of patients with a known UA was even less. A positive relationship was found between the presence of AH and IGT with the frequency of UA control (p

Aim. To identify the main problems of statin therapy in patients with high and very high cardiovascular (CV) risk in real clinical practice.Material and methods. The general information of the study was based on data from 2,457 patients who were included in the register before November 30, 2020: 1,250 men (50.9%) and 1,207 (49.1%) women. A more detailed analysis was performed for groups of patients with high and very high CV risk who had indications for statin treatment at the time of inclusion in the register: out of 2457 patients, 1166 people had very high CV risk, 395 was at high CV risk (a total of 1561 people, the average age of patients was 64.4±11.0 years).Results. Information on the parameters of the lipidogram – the level of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) was available in 1918 (78.1%) and 1546 (62.9%) patients, respectively. Of 1561 patients with high and very high CV risk, TC and LDL-C levels were analyzed in 1221 (78.2%) and 956 (61.2%) cases, statistically significantly more often in patients with high CV risk (p

Aim. To study the two-year survival rate of patients with cerebrovascular accident (CVA) in different age groups.Material and methods. The outpatient part of the REGION-M registry included 684 patients assigned to the City Polyclinic № 64 in Moscow, discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a confirmed diagnosis of stroke or transient ischemic attack. All patients were divided into 5 age groups: group 1 — from 18 to 50 years old (n=72 (10,5%)), group 2 — from 51 to 60 years old (n=122 (17,8%)), group 3 — from 61 to 70 years old (n=156 (22,8%)), group 4 — from 71 to 80 years old (n=185 (27,0%)) and group 5 — 81 years and above (n=149 (21,8%)). Patient survival was assessed after 2 years of follow-up.Results. The mortality rate of patients during the follow-up period significantly increased with age as follows: in patients of 18-50 years old — 4%, 51-60 years old — 9,8%, 61-70 years old — 23,7%, 71-80 years old — 34%, 81-100 years old — 55% (p

Aim. Based on the data from the register of patients with COVID-19 and community-acquired pneumonia (CAP), analyze the duration of the prehospital period, cardiovascular comorbidity and the quality of prehospital pharmacotherapy of concomitant cardiovascular diseases (CVD).Material and methods. Patients were included to the study which admitted to the FSBI "NMHC named after N.I. Pirogov" of the Ministry of Health of the Russian Federation with a suspected or confirmed diagnosis of COVID-19 and/or CAP. The data for prehospital therapy, information from medical histories and a patients’survey in the hospital or by telephone contact 1-2 weeks after discharge were study. The duration of the prehospital stage was determined from the date of the appearance of clinical symptoms of coronavirus infection to the date of hospitalization.Results. The average age of the patients (n=1130; 579 [51.2%] men and 551 [48.8%] women) was 57.5±12.8 years. The prehospital stage was 7 (5,0; 10,0) days and did not differ significantly in patients with the presence and absence of CVD, but was significantly less in the deceased than in the surviving patients, as well as in those who required artificial lung ventilation (ALV). 583 (51.6%) patients had at least one CVD. Cardiovascular comorbidity was registered in 222 (42.7%) patients with hypertension, 210 (95.5%) patients with coronary heart disease (CHD), 104 (91.2%) patients with atrial fibrillation (AF). The inclusion of non-cardiac chronic diseases in the analysis led to an increase in the total proportion of patients with concomitant diseases to 65.8%. Approximately a quarter of hypertensive patients did not receive antihypertensive therapy, a low proportion of patients receiving antiplatelet agents and statins for CHD was revealed – 53% and 31.8%, respectively, anticoagulants for AF – 50.9%.Conclusion. The period from the onset of symptoms to hospitalization was significantly shorter in the deceased than in the surviving patients, as well as in those who required ALV. The proportion of people with a history of at least one CVD was about half of the entire cohort of patients. In patients with CVD before COVID-19 disease, a low frequencies of prescribing antihypertensive drugs, statins, antiplatelet agents and anticoagulants (in patients with AF) were recorded at the prehospital stage.

Aim. To estimate the detection rate of heart failure (HF), using various diagnosis criteria, among patients aftr 12 months after hospital treatment for coronavirus disease 2019 (COVID-19).Material and methods. The study included 185 patients from the TARGET-VIP registry who came for a visit 12 months after hospitalization for COVID-19. To identify HF with reduced (HFrEF) and mildly reduced (HFmrEF) ejection fraction (EF), the European Society of Cardiology (ESC) criteria (2016 and 2021) were used. To identify HF with preserved EF (HFpEF), we used the ESC criteria (2016 and 2021), as well as the 2018 Russian guidelines and H2FPEF score.Results. In the analyzed group, there were no patients with EF

Aim. To study the two-year survival rate of patients with various types of cerebrovascular accident according to the outpatient part of the REGION-M registry.Material and methods. The outpatient part of the REGION-M registry included 684 patients assigned to the City Polyclinic № 64, discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a confirmed diagnosis of stroke or transient ischemic attack (TIA). Of these, 514 (75,1%) patients had an ischemic stroke, 52 (7,6%) — a hemorrhagic stroke, and 118 (17,2%) — a TIA.Results. The lowest two-year mortality (11%) was observed in patients who underwent TIA (p0,05). The mean age of patients who underwent TIA was significantly less than the age of patients with hemorrhagic or ischemic stroke. With increasing age, the survival of patients significantly worsened in all types of strokes. In addition, multivariate analysis adjusted for age showed remained significant effect of the stroke type on survival as follows: the relative risk of death for ischemic and hemorrhagic stroke was 1,99 (95% CI: 1,12-3,53) (p

Aim. To evaluate the medical treatment of patients with cardiovascular disease (CVD) during the first year of follow-up after hospitalization for coronavirus disease 2019 (COVID-19) in a prospective registry.Material and methods. The material for the study was obtained from the database of the TARGET-VIP inhospital registry. The registry included 1130 people. Of 863 patients discharged from the hospital with a diagnosis of COVID-19, 473 (548%) patients with CVD were selected, and 31 (40,8%) patients were selected from 76 patients in whom the diagnosis of COVID-19 was not confirmed with CVD.Results. At the stage of discharge from the hospital, the quality of therapy for CVD was insufficient on average, the frequency of proper prescriptions was 59,5%. During the first year, there was a significant trend towards a decrease in the prevalence of antihypertensive therapy for hypertension (p=0,018), anticoagulants for atrial fibrillation (p

Aim. To study two-year survival and factors affecting it in patients with cerebrovascular accident (CVA) with prior coronary artery disease (CAD).Material and methods. The outpatient stage of the REGION-M registry included 684 patients assigned to the Moscow City Polyclinic № 64, discharged from the F.I. Inozemtsev City Clinical Hospital in the period from January 1, 2012 to April 30, 2017 with a verified diagnosis of stroke or transient ischemic attack. Of these, 423 (61,8%) patients had a diagnosis of CAD in the outpatient records.Results. Patients with CAD were significantly older, more often had comorbidities, disability, and were monitored in the polyclinic before the stroke and after hospital discharge than patients without CAD. During the follow-up period, mortality among patients with CAD (34,3%) was significantly higher than without CAD (19,9%) (p< 0,01), At the same time, mortality in CAD was 2,6 times lower among patients who applied to the polyclinic at least once after discharge (28%) than those who never applied after discharge — 72,9% (p< 0,001), Multivariate analysis confirmed this positive effect (relative risk, 0,998; confidence interval: 0,983-0,992, p< 0,0001).Conclusion. Mortality in patients with stroke and CAD was significantly higher than in those without CAD, while it was significantly lower among patients monitored in the polyclinic in the post-hospital period of stroke.

Aim. Assess the two-year survival rate of patients who have undergone acute cerebral circulation disorder, depending on their commitment to visiting the district polyclinic before and after discharge from the hospital.Material and methods. The outpatient part of the REGION-M register included 684 patients attached to the Moscow City Polyclinic №64, discharged from the Moscow City Clinical Hospital n.a. F.I. Inozemtsev of from 01.01.2012 to 04.30.2017 with a confirmed diagnosis of acute cerebral circulation disorder (cerebral stroke / transient ischemic attack).Results. Of the entire cohort, 83.2% of patients and 84.2% after hospital discharge attended the clinic during the year before the development of reference acute cerebral circulation disorder. Patients who attended the clinic before and after the reference stroke were older, more likely to have diabetes, comorbid disease and disability. For 22 months of follow-up, mortality was 28.8% (197 out of 684 people). Among those who applied and did not apply to the clinic before the reference acute cerebral circulation disorder, the difference in mortality tended to be reliable (27.4% versus 35.7%, p

Aim. To determine the main factors associated with in-hospital mortality in patients after acute cerebrovascular accident based on the medical history data.Material and methods. The study used the data of retrospective hospital part of the REGION-M register, which included all patients hospitalized in one Moscow city clinical hospital from January 1, 2012 to March 30, 2017 with stroke and transient ischemic attack. We analyzed the presence of following parameters’ information in case histories of patients who died in hospital and those who were discharged: risk factors (RF), socio-demographic factors, history of cardiovascular and concomitant diseases. The association of factors recorded at hospital admission with mortality rate was studied, and multivariate logistic regression was constructed. A combination of factors significantly associated with in-hospital mortality was determined.Results. Of 900 patients (365 (40,6%) men and 535 (59,4%) women) included in the REGION-M register, 216 (24,0%) died in the hospital. Assessment of the RF information presence showed that the smoking data was disclosed in 54,3% of case histories, family history — 1,1%, education level — 8,6%, alcohol consumption — 7,4%, disability — 79,1%, hypercholesterolemia — 6,4%. However, there were no significant differences on the completeness of the data collection on the listed RF between deceased and discharged patients. Factors such as gender, age, and outcome were described in all case histories. Univariate analysis of factors significantly associated with patients’ mortality marked out age and history of cardiovascular diseases (coronary artery disease (CAD), atrial fibrillation (AF), venous thrombosis) and/or concomitant diseases (diabetes, anemia). Multivariate logistic regression identified factors associated with increased in-hospital mortality as follows: CAD, AF, diabetes, venous thrombosis.Conclusion. Hospital-based physicians pay little attention to the recording of cardiovascular RF and sociodemographic parameters in patients with stroke, regardless of the condition severity and outcome. In-hospital mortality is associated with age, CAD, AF, diabetes, and venous thrombosis.Region-M register workgroup: Akimova A. V., Arutyunov G. P., Belova E. N., Blagodatskikh S. V., BoytsovS. A., Budaeva I. V., Vernokhae-va A. N., ViskovR. V., Voronina V. P., GladilkinaM. P., DeevA. D., Dmitrieva N. A., Drapkina O. M., Zagrebelny A.V., Kvitivadze G. K., Kudryashov E. N.., Kokareva I. V., Kudryashov E. V., Kutishenko N. P., Lerman O. V., Lukina Yu. V., LukyanovM. M., Martsevich S. Yu., Matveeva A. D., Matske-vich L. A., Mitichkin A. E., Nikitina G. I., Nekoshnova E. S., OvsepyanM. A., Okshina E. Yu., PalamarchukV. N., Parsadanyan N. E., PorezanovaM. V., Stakhovskaya L. V., Stolboushkina E. A., Hapaeva M. A., Chernyshova M. I., Shamalov N. A.

Aim. To assess long-term outcomes within 12 months after hospital treatment of patients with coronavirus disease 2019 (COVID-19) as part of a prospective registry.Material and methods. Outcomes in the posthospital period were assessed in 827 patients diagnosed with COVID-19 (age, 58,0±14,8 years; men, 51,3%). For periods of 30-60 days, 6 and 12 months after discharge from the hospital, cases of death, nonfatal myocardial infarction (MI) and stroke, hospitalization, acute respiratory viral infections/influenza were assessed. The follow-up period was 13,0±1,5 months.Results. During the follow-up period, 35 (4,2%) patients died, 6 (0,73%) and 4 (0,48%) cases of MI and stroke were registered. In addition, 142 (17%) patients were hospitalized, while 217 (26,2%) patients had acute respiratory viral infections/ influenza. Factors of age and length of intensive care unit stay were significantly associated (p

Aim. According to hospital-based registry, to evaluate the age characteristics and prevalence of concomitant cardiovascular and non-сardiovascular diseases in patients hospitalized with COVID-19 during epidemic wave.Material and methods. The TARGET-VIP register included 1130 patients aged 57,5+12,8 years (men, 51,2%) hospitalized at the Pirogov National Medical and Surgical Center from April 6, 2020 to June 22, 2020 with COVID-19. Cardiovascular diseases (CVDs) were diagnosed in 51,6% of patients, non-сardiovascular chronic diseases — in 48,6%, while CVDs and/or non-сardiovascular chronic diseases — in 65,8% of patients.Results. The average age of patients significantly increased by an average of 0,77 years per week (p

Aim. To assess the quality of medication treatment in the polyclinic within 2 years after discharge, depending on presence/absence of diarecommended for patients with stroke before its development and betes.Material and methods. The study included 684 patients assigned to the City Polyclinic № 64 (Moscow), discharged from F.I. Inozemtsev City Clinical Hospital (Moscow) for a period from January 1, 2012 to April 30, 2017 with a diagnosis of stroke/transient ischemic attack, of which 122 were diagnosed with diabetes.Results. Before stroke, therapy was recommended for 67,3% of patients with diabetes and 54,7% without diabetes (p

Aim. To study adherence to treatment with new oral anticoagulants (NOAC) and factors associated with it in patients with non-valvular atrial fibrillation (AF) within the outpatient PROFILE registry.Material and methods. ANTEY study included 201 patients with AF from the PROFILE registry (89.3%): 118 males (58.7%) and 83 females (41.3%), aged 71.1Ѓ}8.7 years. The study consisted of two visits half a year apart (V0, V1) and a phone contact (PC) one year after V0. During V0 all patients were recommended to start therapy with one of the NOACs. Adherence to therapy was assessed during all visits with the use of the original questionnaire – National society of evidence-based pharmacotherapy (NSEPh) adherence scale, 8-item Morisky Medical Adherence Scale (MMAS-8) and direct doctors’ questioning.Results. During V0 111 (55.2%) patients were recommended the use of rivaroxaban; 47 (23.4%) – the use of dabigatran and 43 (21.4%) – the use of apixaban. During V1 based on the results of the NSEPh adherence scale 155 (77.5%) patients were completely adherent (strictly followed doctors’ recommendations), 5 patients were partially adherent (violated doctors’ recommendations), 7 patients were partially non-adherent (stopped taking NOACs), and 33 patients were completely non-adherent (did not start taking NOACs). Out of 197 patients who completed MMAS-8 questionnaire 157 (79.7%) patients were partially adherent to treatment and 40 (20.3%) patients were non-adherent. None of the patients were completely adherent to treatment. According to doctors’ questioning, by the time of the PC 15 patients had not started taking the recommended NOAC – were completely non-adherent (CNA). According to the NSEPh adherence scale, by the time of the PC out of 197 patients (4 patients died) 158 patients were completely adherent to treatment, 6 – partially adherent, 18 – partially non-adherent and 15 – CNA. According to MMAS-8, by the time of the PC 153 (77.7%) patients were partially adherent to treatment, and 44 (22.3%) patients – non-adherent (none of the patients were completely adherent). Out of 15 CNA patients MMAS-8 revealed only 4 (27,6%) during B1, and 6 (40%) during the PC. NSEPh adherence scale revealed all CNA patients. The main reason for refusing to start NOAC therapy was their high price. Recently started use of NOACs was stopped mostly due to adverse effects of therapy (bleeding). The most common factors increasing patients’ adherence to NOACs were previous experience of taking this group of drugs and no history of any adverse effects during therapy.Conclusion. The ANTEY study showed relatively high adherence to NOACs prescribed by doctors of the specialized cardiology department of the scientific center. The most common factors associated with early non-adherence to the new drug were high price and adverse effects of therapy, the latter influenced prolonged adherence as well. Previous experience of taking this group of drugs and no history of any adverse effects during therapy increased adherence to NOACs.

Aim. To study the adherence to medication and visits in healthcare facilities and to assess some parameters of the treatment quality among patients who previously participated in randomized controlled trials (RCT).Material and methods. The TRUST (Influence of Participation in Randomized Controlled Trials on adheRence to Medicines’ Intake and regular viSits to the docTor) study included patients from the outpatient register PROFILE. The main group included patients, who from 2011 to 2018 at different times participated in one or more of the 16 international RCT — 102 patients: 53 women (52%) and 49 men (48%). The mean age of patients was 71±10 years. These 16 RCTs included patients with different cardiovascular diseases and risk factors. Personal or telephone contact was established with patients or their relatives from March to June 2019. The vital status of 88 patients was determined: 9 patients died (phone contact with relatives), 77 patients answered to questionnaires, 2 persons declined to participate in the survey.Results. 59 patients (76,6%) visit a cardiologist at least once every 6 months, and 6 patients (7,8%) visit a cardiologist once a month. Patients who participated in RCT had high adherence rates. Thus, 33 patients (42,9%) showed high adherence, 34 patients (44,1%) — average and only 10 patients (13%) — low. Among patients with coronary artery disease, significantly higher adherence to drug therapy was observed: 25 of 48 patients (51,2%) demonstrated high adherence (p=0,015). Similar values were demonstrated in the group of diabetes patients — high adherence was observed in 17 (60,7%) of 28 patients (p=0,015). Among patients with heart rate disturbances high adherence was observed in 13 (72,2%) of 18 patients (p=0,09).Conclusion. Preliminary results of the TRUST study confirm that previous patient involvement in RCTs has a positive effect on subsequent treatment adherence after RCT.

Aim. To assess the features of cerebral stroke course in patients with diabetes mellitus (DM) within the framework of the register of acute cerebrovascular event (ACVE) REGION-M.Material and methods. From 2012 to 2017, the REGION-M register includes 900 patients who were admitted to one of the clinics in Moscow and had a stroke or transient ischemic attack.Results. Patients with diabetes were older than patients without diabetes and impaired glucose tolerance (73,7+11,1 years vs 69,6±14,7 years (p

Aim. To assess the demographic and clinical characteristics, drug treatment and outcomes in patients with a history of acute cerebrovascular accident (ACVA) and with concomitant history of myocardial infarction (MI) in clinical practice based on outpatient and hospital parts of REGION registry.Material and methods. The total 1886 patients with a history of ACVA (aged of 70.6±12.5 years, 41.9% men) were enrolled into the outpatient registry REGION (Ryazan) and the hospital registry REGION (Moscow). 356 patients had ACVA and a history of MI (group “ACVA+MI” and 1530 patients had ACVA without history of MI (group “ACVA without MI”). The incidence of cardiovascular diseases (CVD), non-CVD comorbidities, drug therapy and outcomes were analyzed.Results. In the group ACVA+MI compared with group ACVA without MI the significantly higher proportions of patients with the following conditions (diagnosis) were revealed: arterial hypertension (AH) – 99.1% and 94.2%; coronary heart disease (CHD) – 100% and 57%; chronic heart failure (CHF) – 61.5% and 41.8%; atrial fibrillation (AF) – 42.7% and 23.8%; repeated ACVA – 32.9% and 18.9%, respectively, p

The aim to evaluate medical appointments, as well as awareness, adherence and attitude of patients to medical treatment of obesity based on the results of a survey of patients with a prospective outpatient registry.Materials and methods. Total 305 patients with obesity in the outpatient “PROFILE” register were surveyed, including self-assessment questions regarding their own body weight, prescription of obesity treatment by doctors, patients’ adherence to the implementation of these recommendations, propensity to self-medication and information about personal financial costs for the treatment of this disease. 42 (12 %) patients refused to participate in the survey. 213 people (69.8 %) who answered the questionnaire were diagnosed with obesity of the 1st degree, 63 (20.7 %) – obesity of the 2nd degree; obesity grade 3 was detected in 29 people (9.5 %). Waist circumference in women averaged 104.7 ± 12.9 cm, in men – 116.7 ± 9.6 cm – all patients had abdominal obesity. 263 (86.2 %) people had arterial hypertension, 117 (38.4 %) patients had coronary heart disease; type 2 diabetes mellitus was diagnosed in every fourth patient (85 (27.2 %) people); atrial fibrillation was diagnosed in 55 (18 %) patients; 48 (15.7 %) people had a history of myocardial infarction, 23 (7.5 %) patients had a stroke.Results. According to the survey results, only one in four patients – 77 (25.2 %) – out of 305 patients who participated in the survey knew about the possibility of drug treatment of obesity. Mostly, patients received recommendations for non-drug treatment of obesity: 242 patients (79.3 %) were recommended to reduce caloric intake, 194 (63.6 %) – increased physical activity. Only 37 (12.1 %) patients with obesity were recommended for weight correction, significantly more often they were recommended and taken by patients with 2 and 3 degrees of obesity compared to patients with obesity of 1 degree (p

Aim. To assess the influence of addition of nicorandil on long-term cardiovascular complications in patients with chronic coronary artery disease (CAD) in the framework of a prospective observational study.Material and methods. Prospective observational multicenter NIKEA study included 590 patients with stable CAD. All patients were recommended to add nicorandil to their baseline therapy. After 21 months, 547 telephone contacts were made, the life status of 524 people was specified, 23 patients were lost to follow-up. The following complications were registered: death from any cause; non-fatal myocardial infarction (MI); non-fatal stroke; urgent myocardial revascularization; hospitalization due to deterioration of CAD, chronic heart failure (CHF) or atrial fibrillation (AF). In 479 patients, a telephone survey was performed to identify adherence (persistence) to nicorandil– i.e. to verify the continuing the treatment for the prescribed duration.Results. During the follow-up period, 15 deaths were recorded, the causes of which were as follows: 3 CAD (2 MI, 1 left ventricular aneurysm), 1 pulmonary embolism, 2 CHF; 1 stroke, 1 oncology, 1 bilateral pneumonia. In the remaining 6 cases, the causes of death were not known. Cardiovascular (CV) complications were MI (8 cases in 7 patients, 1 patient had 2 MI in the follow-up period, 3 patients from this group died), stroke in 6 patients (7 cases, 1 patient had 2 strokes, 1 patient died). Urgent percutaneous coronary intervention was performed in 3 patients (in 2 patients due to acute MI, in 1 patient due to unstable angina). During the observation period, 21 people were urgently hospitalized due to deterioration of clinical condition. According to the results of a medical survey, by the end of the follow-up period, 237 people were not adherent to prescribed nicorandil, and 242 patients took the recommended medication (adherent patients). The main cardiovascular complications and death from any cause (р

Aim. To characterize patients admitted to hospital with suspected or documented COVID-19 infection and community-acquired pneumonia (CAP) and to assess the prevalence of concomitant cardiovascular, non-cardiac diseases, prehospital cardiovascular therapy and outcomes of in-hospital treatment.Material and methods. The TARGET-VIP registry includes patients admitted to the N. I. Pirogov National Medical and Surgical Center with suspected or documented COVID-19 infection and/or CAP for the period from April 6, 2020 to July 2, 2020. COVID-19 infection was diagnosed using polymerase chain reaction (PCR) tests and chest computed tomography (CT). Comorbid conditions and pre-hospital therapy were assessed.Results. A total of 1,130 patients were included in the registry (mean age, 57,5±12,8 years; men, 579 (51,2%)). Using PCR test, COVID-19 infection was established in 686 (60,7%) patients; using chest CT − 334 (29,6%) patients. The most numerous were the group with a combination of COVID-19 and CAP (n=662; 58,6%) and the group with CAP without positive PCR (n=402; 35,6%). The group of patients with COVID-19 without CAP was the smallest (n=24; 2,1%); in 3,7% of patients (n=42), CAP was not confirmed and PCR were negative. The proportion of people with cardiovascular diseases (CVD) according to the survey, in comparison with data of medical records, was higher by 2% (52,2 vs 50,2%); the proportion of persons with chronic non-cardiac diseases − higher by 6,7% (50,8 vs 44,1%). Among patients with CVD (n=598), compared with patients without CVD (n=532), following diseases was diagnosed significantly more often: diabetes (odds ratio (OR), 5,66; 95% confidence interval (CI), 3,52-9,12), respiratory disease (OR, 2.,7; 95% CI, 1,43-4,27), chronic kidney disease (OR, 3,32; 95% CI, 1,97-5,59), obesity (OR, 15,35; 95% CI, 6,62-35,59). Hospital mortality was 4,2% and significantly differs (4,7 times) in patients with and without COVID-19 according to PCR (6,6 vs 1,4%, p=0,0001), including among patients with CAP and positive or negative PCR (6,0 vs 1,2%, p=0,0002).Conclusion. COVID-19 infection was diagnosed in 60,7% of patients according to PCR and in 90,3% of patients according to the combination of PCR and chest CT. Among patients with CVD, the proportion of people with chronic noncardiac diseases was significantly higher (regardless of age and sex), in particular, with diabetes, chronic kidney disease and obesity. Questionnaires provided important data on the history of noncommunicable diseases and prehospital cardiovascular therapy. The mortality rate of patients with documented COVID-19 infection was 4,7 times higher than with undocumented.

Aim. To assess adherence to new oral anticoagulants (NOAC) or warfarin therapy and to study the factors influencing adherence in nonvalvular atrial fibrillation (AF) patients on different stages of treatment within the prospective outpatient registry of patients with cardiovascular diseases.Material and methods. The study included 201 patients with nonvalvular AF (males, 118 (58,7%)) from the outpatient registry PROFILE). Mean age was 71,1 ±8,7 years. Study protocol consisted of the inclusion visit (V0), 6-month follow-up visit (V1) and phone contact 1 year after V0 (PC). In V0, all patients were prescribed one of the NOACs. At V1 doctors could recommend warfarin or another NOAC to patients, who have refused taking prescribed NOAC. Medical adherence was determined using the of the National society of evidence-based pharmacotherapy (NSEPh) adherence scale. NSEPh adherence scale allows to grade patients’ adherence to treatment into 4 categories: 1) completely adherent, 2) partially adherent, 3) completely non-adherent, 4) partially non-adherent. Dichotomous grading into adherent (completely adherent) and non-adherent (rest of patients) was also used.Results. Out of 201 included patients, 200 came to V1 (1 patient died). PC was successful in 197 patients (3 patients died). According to NSEPh adherence scale, 155 (77,5%) patients at V1 were completely adherent, 5 (2,5%) — partially adherent, 7 (3,5%) — partially non-adherent, 33 (16,5%) — completely non-adherent. By the PC, 158 (80,2%) patients were completely adherent to the OAC therapy, 6 (3,0%) — partially adherent, 28 (14,2%) — partially non-adherent, 15 (7,6%) — completely non-adherent. At all stages of treatment, the following factors of good adherence remained significant: never-smoking, prior NOAC use, negative history of any treatment-related adverse effects (AEs). Patients with comorbidities and a history of bleeding during OAC therapy were more likely to discontinue initial scheme and violate treatment regimen (p

Aim. To study adherence to treatment with generic statins prescribed to patients with high and very high cardiovascular risk in routine clinical practice, as well as the possible impact of educational training of doctors on compliance with clinical guidelines and changes in patient adherence to treatment. Material and methods. The study was prospective, with educational training for physicians on the main provisions of current clinical guidelines prior to the program. It included 3 visits over 12 weeks: inclusion visit (V0), and visits after 1 and 3 months of follow-up (V1 and V3). The use of generic atorvastatin or rosuvastatin was recommended for all patients. To assess adherence the following surveys were used: medical survey (all visits), the original questionnaire to assess the potential and the actual commitment to taking statins and the causes of non-adherence, and the Morisky-Green 8-question test (visits V0 and V3) to evaluate overall adherence to drug treatment. The patients who started the drug taking according to the medical recommendations and continued it during the study were considered as adherents. Patients who started but stopped taking the drug for 12 weeks were considered as partially non-adherent. Patients who refused to take the recommended statin were considered as non-adherents. The prescribed doses of statins and medical tactics in the titration of doses, as well as the achievement of the target level of low-density lipoprotein cholesterol (LDL cholesterol) were evaluated. Results. 112 (37.5%) of the 298 patients with baseline indications for taking statins did not take these drugs. According to the medical survey at V0 a total of 286 (96%) patients were potential adherents to medical recommendations; at V3 262 (88%) patients were adherent to statin treatment; 34 patients were partially non-adherent, 1 – was non-adherent, and 1 – dropped out of the study immediately after V0. According to the original questionnaire, potential adherence was assessed in 281 patients: 244 (86.8%) were potentially adherent, 37 (13.2%) – partially non-adherent. At V3, out of 294 patients who filled in the original questionnaire, 260 (88.5%) were adherent, 26 (8.8%) – partly non-adherent, 8 (2.7%) – nonadherent. The Morisky-Green questionnaire was filled in by 292 patients: at V0, 106 patients (36.3%) had treatment adherence, non-adherence – 186 patients (63.7%). By V3, an increase in total adherence was found: 159 patients (54.5%) were adherent, and 133 (45.5%) – non-adherent. The lipid profile was evaluated in 231 patients in V1 and in 285 ones – in V3. The target LDL cholesterol level was reached by V1 in 47 (20.3%) patients, and in 184 (79.7%) patients – was not. Dose titration occurred in 56 patients. By V3, 121 (42.4%) patients reached the target level of LDL cholesterol, and 164 – did not. The results of the lipid profile analysis were erroneously interpreted in 21 patients. Conclusion The results of the medical survey and the original questionnaire for assessing adherence predominantly coincided. The Morisky-Green test does not accurately reflect patients' commitment to taking a particular drug. Clinical inertness of doctors in the titration of statin doses and achievement of target LDL cholesterol levels were found as well as erroneous interpretation of the LDL cholesterol level. Educational trainings for doctors had a positive effect on the implementation of clinical guidelines, and also contributed to increasing patient adherence to medical recommendations.

Aim. To determine the features and main problems of statin therapy, as well as assess the possibility of achieving the target level of lipid pattern in patients with high and very high cardiovascular risk (CVR) in real clinical practice.Material and methods. The design of the “PRIORITET” observational program is an open observational study. Patients with high and very high CVR were divided into 3 groups in accordance with the initial data: (1) not taking statins, (2) taking statins, but not reaching the target low-density lipoprotein cholesterol (LDL-C) level, (3) taking statins with the achievement of the target LDL-C level, which is justified in replacing the statin inside the class — adverse effects (AE), high price, etc. Within 12 weeks 3 visits of patients to hospitals were carried out: baseline visit (B0), visit 1 month after the study initiation (B1) and visit 3 months after the study initiation (B3). The choice of atorvastatin or rosuvastatin was assessed by the doctors.Results. Groups 1, 2 and 3 included 112, 170 and 16 people, respectively. At B0, 145 (48,7%) patients were prescribed atorvastatin, and 153 (51,3%) — rosuvastatin. Three people dropped out of the study to B3, 295 patients completed the program. Lipid pattern of 285 patients were analyzed: 121 (41%) people (101 with very high CVR and 20 with high CVR) achieved the target LDL-C level, the remaining 164 (59%) patients (CVR — 156 and 8, respectively) — no. The most pronounced dynamics of LDL=C level was revealed in group 1, the differences between group 1 and groups 2 and 3 are highly statistically significant (p

Aim. To assess the characteristics of patients and short-term outcomes of the disease in patients hospitalized for cerebral stroke (CS) based on the REGION-Moscow register.Material and methods. From 2012 to 2017, 900 patients were included in the REGION-Moscow register, who were consecutively admitted to one of the clinics in Moscow, and in whom CS or transient ischemic attack (TIA) were diagnosed during hospitalization.Results. The average age of the entire cohort of patients was 71±15 years. Women were 59,4%, men — 40,6%. The average age of women was 7 years more than the average age of men. Cardiovascular risk factors or a combination of them were detected in most patients. About 75% of CS were ischemic, 10% — hemorrhagic, 2% — mixed type, 13% were transient ischemic attack. Hospital mortality on average over the 5 years were 24,0%. There was a sharp increase in hospital mortality in 2014, which coincided with the organization of the vascular center, in subsequent years there was a progressive decrease in hospital mortality.Conclusion. The development of CS in most patients was predictable and determined mainly by the presence of cardiovascular risk factors or a combination of them. Organization of the vascular center led to a gradual decrease in hospital mortality.Boytsov S. A.5 on behalf of the working group.REGION-Moscow register working group: Akimova A. V., Arutyunov G. P., Belova E. N., Blagodatskikh S. V., Boytsov S. A., Vernohaeva A. N., Viskov R. V., Voronina V. P., Gladilkina M. P., Deev A. D., Dmitrieva N. A., Drapkina O. M. Zagrebelny A. V., Kvitivadze G. K, Klyashtorny V. G., Kokareva I. V. , Kudryashov E. V., Kutishenko N. P., Lerman O. V., Lukyanov M. M., Martsevich S. Yu., Matveyeva A. D., Matskevich L. A., Mitichkin A. E., Nikitina G. I., Nikoshnova E. S. Ovsepyan M. A., Okshina E. Yu., Palamarchuk V. N., Parsadanyan N. E., Porezanova M. V., Sementsov D. P, Stakhovskaya L. V., Stepina E. V., Stolboushkina E. A., Halaeva M. A., Chernyshova M. I., Shamalov N. A.

Aim. To assess quality of life (QoL) and its dynamics during nicorandil treatment in patients with stable ischemic heart disease, to study the relationship of treatment adherence and QoL indicators when treated with nicorandil.Material and methods. Observational program NIKEA included 590 patients with angina pectoris. Seattle Angina Questionnaire (SAQ) was used to assess QoL. Patients completed SAQ at the visit of inclusion (V0) and at the visit after 3 months of observation (V3). Potential and actual adherence to therapy was assessed by medical interviews at visits V0, V1 (1 month of observation) and V3. During the visit V0 417 people (from 590 ones enrolled into the study) completed SAQ (71% response); after 3 months (V3) SAQ was filled in by 454 of 552 people who came to this visit (82% response). According to the results of medical interviews, potential adherence (visit V0) was determined in all 590 patients, actual adherence to nicorandil (visits V1 and V3) was assessed in 552 patients who came to these visits. In accordance with the degree of adherence, all patients were divided into 3 groups: (1) adherent to treatment (taking nicorandil for the first three months), (2) non-adherent (who refused to take nicorandil), and (3) partially non-adherent (who started nicorandil, but for various reasons stopped taking the drug).Results. In all patients, regardless of their adherence to the recommended drug, there was an increase in QoL according to all five scales of the SAQ after 3 months of follow-up. Statistically significant positive dynamics of all SAQ indicators was found only in adherent patients (p

Aim. In the circumstances of real clinical practice, to evaluate the changes in life quality (LQ) parameters of the patients with coronary heart disease and stable angina with addition of nicorandil to standard treatment.Material and methods. Study design — prospective, observational, multicenter. In the trial, the physicians participated, from 14 institutions in a range ofRussia regions. Totally, 590 included: 261 (44,2%) females, 329 (55,8%) males. All patients, in addition to the standard antianginal treatment, were prescribed with nicorandil. At the visits V0 (baseline) and V3 (3 months of therapy) they completedSeattle questionnaire (SAQ) of LQ assessment. Five parameters were assessed: exercise intolerance, attacks frequency, stability, attitudes toward disease, treatment satisfaction. At the visit V0 417 questionnaires were completed (response 71%), at V3 — 454 (response 82%).Results. The significant increase was demonstrated, for parameters by SAQ in 3 months of observation, the highest parameters, except the scale exercise intolerance, were found in the group taking nicorandil during 3 months of follow-up (p

Working Group of the NIKEA Program. Ekaterinburg: Akulina E.N.; Izhevsk: Shinkareva S. E., Grebnev S.A.; Krasnodar: Kudryashov E.A., Fendrikova A.V.; Krasnoyarsk: Nemik D.B., Pitaev R.R., Altaev V.D., Samokhvalov E.V., Stolbikov Y.Y.; Moscow: Dmitrieva N.A., Zagrebelnyy A.D., Zakharova A.V., Balashov I.S., Leonov A.S., Sladkova T.A., Zelenova T.I., Shestakova G.N., Kolganova E.V., Maksimova M.A.; Novosibirsk: Moskalenko I.V., Shurkevich A.A.; Omsk: Loginova E.N., Gudilin V.A.; Orel: Zhuravleva L.L., Lobanova G.N., Luneva M.M.; Orenburg: Kondratenko V.Y.; Rostov-on-Don: Kalacheva N.M., Kolomatskaia O.E., Dubishcheva N.F., Romadina G.V., Chugunova I.B., Skarzhinskaia N.S.; Ryazan: Bulanov A.V., Trofimova Y.M., Nikolaeva A.S.; St. Petersburg: Savinova E.B., Ievskaia E.V., Vasileva L.B.; Tula: Zubareva L.A., Berberfish L.D., Gorina G.I., Nadezhkina K.N., Iunusova K.N., Nikitina V.F., Dabizha V.G., Renko I.E., Soin I.A.Aim. To study the adherence to treatment and the factors that affect it in patients with stable coronary heart disease during the treatment with nicorandil. Material and methods. The use of nicorandil in addition to standard antianginal therapy was recommended to patients (n=590) in a prospective, observational, multicenter NIKEA study. Patients completed original questionnaires on adherence, including a Morisky-Green test at the enroll visit. The questionnaires were filled by 423 patients (73% response). The factors that influence adherence were studied.Results. All patients were divided into 3 groups, depending on the adherence to the use of nicorandil: immediately refused to take the drug (n=150; group 1); started, but stopped taking nicorandil in the first 3 months of observation (n=75; group 2); who took nicorandil for 3 months (n=327; group 3). Potentially adherents (intention to treat) were 582 out of 590 (98.6%) patients, and actually adherents – only 327 of 552 (59.2%) patients. The main reason for non-adherence to the beginning of therapy is polypharmacy; to the continuation of the treatment that had just started – adverse events; for termination of long-term therapy – polypharmacy, adverse events and insufficient effectiveness of treatment. Group 3 had initially more severe angina pectoris: more number of angina attacks (p=0.014) and the need of short-acting nitrates (p

Aim. Under the framework of the outpatient registry PROFILE, to assess cardiovascular risk factors (CVR) related to food and physical activity (PA) in obese patients, using questionnaires.Material and methods. Into the study, obesity patients were included, from PROFILE registry, of those 91 completed survey on food behavior and PA.Results. The prevalence of obesity, by the registry data, was 38,8% (47,3% in women and 52,7% in men). Patients had high and very high CVR by SCORE. Arterial hypertension was found in 85,7%, and the same number had dyslipidemia, coronary heart disease — in 34,1%, glucose intolerance and type 2 diabetes — in 12,1% and 20,9%, respectively, smokers were 16,5%. Most patients had in their food related behavior the adverse factors such as low amount of fruits and vegetables, excess of refined carbohydrates and salt. In 48,4% of patients there was low level of PA. All obesity patients present with a characteristic combination of CVR factors.Conclusion. Surveying of patients under framework of outpatient registry makes it to reveal CVR factors related to food and PA, in real clinical practice.

Working group of the “GRANAT-2” study: Tula - Trubitsyn G.I., Ivanov Yu.V., Mirenkova O.K., Eskova R.A., Simonova R.P., Milon M.E., Telegina E.V., Kuznetsov A.M., Zhukova N.A., Zainullina I.K.; Rostov-on-Don - Budanov O.V., London E.M., Minosyan L.V., Nedashkovskaya N.G., Ter-Ananyants Ye.A.; Tomsk - Proskokova I.Yu., Permyakova O.V., Politova L.V., Maneeva I.D., Ivanova S.Yu.; Nizhny Novgorod - Larina O.V., Pokrovskaya I.N., Patselt E.A.; Moscow - Sladkova T.A., Zelenova Т.V. Aim. To study the tolerability and adherence to antihypertensive therapy in patients with hypertension and chronic obstructive pulmonary disease (COPD) using the fixed combination of ramipril and amlodipine in the observational program for patients with arterial hypertension and COPD (GRANAT-2). Material and methods. Patients with hypertension and COPD (n=52) with all inclusion criteria and without exclusion criteria who signed informed consent to participate in the GRANAT-2 program were included into the study. The use of a fixed combination of ramipril and amlodipine was recommended in all patients. The doses were determined by the treating physicians in accordance with the official drug instruction. The patients had 4 visits, and the duration of the study was 5 months. The Morisky-Green test was used to assess an adherence of patients to treatment. Assessments of blood pressure, adverse events were performed at all visits. Results. 50 of 52 patients completed the study: 45 patients used the studied fixed combination in the recommended doses, and 5 patients used other antihypertensive drugs, 2 patients withdrew from the study. Systolic blood pressure after 1 month of treatment decreased by an average of 20 mm Hg from the baseline, and diastolic blood pressure – by 10 mmHg. These rates after 5 months of therapy were 29 mm Hg and 15 mm Hg, respectively. Target blood pressure level was achieved in all patients. Increase in adherence of patients to treatment (according to the Morisky-Green test from 21.1% to 65.1%) was found. 2 cases of adverse events (dry cough) were registered. The discrepancy in adherence assessment was revealed between the results from the Morisky-Green test and the data from program case report forms. Conclusion. Regular patient visits to the doctor and the rapid achievement of an antihypertensive effect with good tolerability of a fixed combination of ramipril and amlodipine contributed to the increase in adherence of patients to treatment. Undesirable effects of the drug therapy are significant, but not leading factors that have a negative impact on the patient adherence to treatment.

Aim. To study some aspects of antihypertension therapy (AHT) adherence in patients with arterial hypertension (AH) and metabolic syndrome (MS) by an example of fixed combination of ramipril and amlodipine, under the framework of GRANAT-1 trial (Observational Program for Patients with Arterial Hypertension and Metabolic Syndrome).Material and methods. Totally, 101 patient included, having had confirmed AH and MS. All participants completed the study. All patients consented to participate, had been recommended the combination drug AHT — fixed combination of ramipril and amlodipine (Egipres) in various dosages selected by clinician in routine assessment. Every patient was invited to clinic for 4 visits during 5 months with interval 1-2-2 months (visits 1-4). For assessment of the general adherence to clinician recommendations (CR) during the first and final visits, all patients filled the Moriskos-Green test (MG) including 4 questions. In all visits, patients were assessed BP level, heart rate, and during visits 2-4 there was adverse events evaluation (AE). Also, the real adherence was evaluated by the intake of Egipres, and activeness of clinicians towards the achievement of target BP levels in participants.Results. The recommended AHT started taking 95 patients, by the end Egipres was being taken by 92 participants, 9 of them took other AHT. 90 patients achieved target BP (81 taking Egipres). Effect of the prescribed at visit 1 AHT in most patients appeared by 1 month (visit 2): in every third patient the target BP was reached, and mean systolic BP decreased by 17,2 mmHg and diastolic BP by 7,7 mmHg (visit 2), and 31,0 mmHg and 16,1 mmHg, resp. — by visit 4. Totally, 3 AE registered, probably amlodipine-related. A significant improvement of total adherence was found: if at the beginning of study, by MG test only 22 (21,8%) adhered, by the end — 70 (69%) of patients. In three cases there was lack of clinician activity to help achieve target BP.Conclusion. Single-time usage of the fixed combination of amlodipine and ramipril, its high efficacy and safety with regular visiting of physician help to increase general adherence of patients to treatment.

Aim. To assess the main features of the clinical course of acute cerebrovascular accident (ACVA), its short-term and long-term outcomes and quality of pharmacotherapy based on hospital register. Material and methods. The hospital register of acute stroke (AS) was organized in one of the cardiovascular centers in Moscow city. The results of the pilot part of the study are presented (170 patients hospitalized from January 01, 2014 to September 30, 2014 with ACVA living in the service area of one of the closest outpatient clinics). Presence of cardiovascular diseases (CVD) and their risk factors (RF), prehospital therapy, short-term complications including death and pharmacotherapy recommended to survived patients were analyzed using hospital medical records. During ambulatory follow-up (prospective part of the register) the vital status and pharmacotherapy were assessed. Results. The majority of patients with AS had concomitant CVD (on average 2 per patient) and non CVD (on average 1.2 per patient). Data on the risk factors of CVD and their complications were reflected insufficiently in the medical records. Most patients in the prehospital period did not receive adequate treatment for the reduction in the cardiovascular risk. 90 patients survived and were discharged. 1.5-2 years after discharge, information on the vital status was available for 78 (86.7%) patients. 61 of them (78.2%) were alive and 17 (21.8%) died. Conclusion. The pilot part of the REGION register revealed that the majority of patients with AS have concomitant CVD and non-CVD. The overall quality of pharmacotherapy, primary and secondary prevention of ACVA was far from that recommended in clinical guidelines, especially during follow-up in outpatient clinic.

Aim. To evaluate possibility of complex pharmaceutical effect simultaneously on 2 risk factors – arterial hypertension (HT) and hypercholesterolemia (HH) in patients with high risk of cardiovascular complications (CVC).Material and methods. 101 patients with HT of 1-2 stage, HH and high risk of CVC (SCORE>5) were included in the study. Patients were randomized in 2 groups: active therapy group (ATG) and control group (CG). ATG patients were actively treated for HT and HH control. The long-acting nifedipine (Nifecard XL, LEK) 30 mg once daily (OD) was prescribed as start antihypertensive drug. Hydrochlorothiazide 12,5 mg/day OD and bisiprolol 5 mg OD was added if antihypertensive effect was insufficient. Atorvastatin (Tulip, LEK) 20-40 mg OD was prescribed for HH control. Management of CG patients was performed by doctors of out-patient clinics. The study duration was 12 weeks.Results. Systolic and diastolic blood pressure (BP) levels in ATG patients were lower than these in CG patients. Target BP level was reached in 88,4% of ATG patients and only in 48,9% of CG patients. Cholesterol of low density lipoprotein (CH LPLD) level was also lower in ATG patients than this in CG patients. Target CH LPLD level was reached in 37,2 % of ATG patients and in 8,3 % of CG patients. Relative risk of CVC was significantly lower in ATG patients than this in CG patients.Conclusion. SAFARI trial shows that effective pharmaceutical simultaneous control of 2 key risk factors, HT and HH, results in risk reduction of CVC.

Aim. To compare efficacy of ramipril generic Hartil® (Egis) to original drug Tritace® in patients with arterial hypertension (HT) of 1-2 degree and high cardiovascular risk, and to evaluate target blood pressure (BP) achievement when taking each drug separately and in combination with the calcium channel blocker amlodipine.Material and methods. A total of 27 patients (14 men, 13 women) with HT of 1-2 degree and high risk due to combination of HT with ischemic heart disease, diabetes or previous stroke were included in an open randomized crossover study. Each patient received generic and original ramipril during 6 weeks by turns. Antihypertensive efficacy (the target BP level

Aim. To study the clinical equivalence of original and generic drugs of bisoprolol in patients with arterial hypertension (HT) 1-2 degrees according to protocol recommended by the Society of Cardiology of the Russian Federation for comparative studies. Material and methods. 30 patients with HT 1-2 degrees were examined. Patients were randomized into group 1 (original bisoprolol 5 mg/day) or group 2 (generic bisoprolol 5 mg/day). In case of insufficient antihypertensive effect bisoprolol dose was increased or S-amlodipine and then indapamide were added. After the first treatment period (8 weeks) was completed 2-week wash-out period started and then the second period (8 weeks) of treatment (taking alternative medicine of bisoprolol) began. Blood pressure (BP), heart rate, ECG, adverse effects were recorded in patients. Results. After 8 weeks of therapy BP reduction was 27.2±12.2/12.0±6.1 mm Hg in group 1 and 29.9±10.5/12.5±7.2 mm Hg in group 2 (p

Aim. To study adjuvant effect of betahistine dihydrochloride to ACE inhibitors in patients with chronic heart failure (CHF) class II-III suffering from giddiness.Material and methods. 61 patients with CHF class II-III, ejection fraction ≤45% (Simpson) suffering from giddiness were involved into randomized open parallel study. Patients were randomized to Betahistine dihydrochloride plus basic CHF therapy or only basic therapy groups. Enalapril dose titration was performed in all patients. Quality of life and giddiness severity evaluation, electrocardiogram was performed initially and after treatment. Clinical examination results, drug therapy and adverse event were registered at each visit.Results. The target ACE inhibitor dose (≥20 mg daily) was reached in 97 % of patients. It led to significant reduction of dyspnea, edemas, CHF class reduction and life quality increase. Significant differences between investigated groups were not found. Reduction of giddiness severity was shown in both groups. There was a trend to more prominent improvement of life quality (р=0,08) and more frequent achievement of target ACE inhibitor dose in patients treated with betahistine dihydrochloride.Conclusion. The target ACE inhibitor dose can be achieved more than in 90% of patients with CHF class II-III without hypotension symptoms. Adjuvant usage of betahistine dihydrochloride is necessary in patients with CHF still suffering from giddiness after achievement of target ACE inhibitor dose.

Aim. To study the efficacy and safety of generic valsartan Valz (Actavis Group, Iceland) in comparison with the original valsartan Diovan® (Novartis, Switzerland) in patients with arterial hypertension (HT) of 1-2 degrees and metabolic syndrome. Material and Methods. 30 hypertensive patients (12 men and 18 women) were enrolled in a randomized open-label crossover study. Each patient received generic and original valsartan (80 mg QD) sequentially during 8 weeks. When target blood pressure (BP) level (0.05). Target BP was achieved in 23 patients (77%) in both randomized groups. Serious adverse reaction were not observed during the treatment with both valsartan drugs. Conclusion. The therapeutic equivalence of generic and original valsartan drugs is shown. Therapy based on valsartan (in combination) was safe and effective in 77% of patients with HT of 1-2 degrees and metabolic syndrome.

Aim. To assess the potential of ursodeoxycholic acid (UDCA) in the prevention of liver dysfunction in patients with cardiovascular diseases (CVD) and high risk of cardiovascular events (CVE) with indications for statins use.Material and methods. Patients (n=262, age 60.1±8.9 years) took statins for secondary prevention of CVE in observational cohort study. The follow-up duration was 6 months. UDCA was recommended for all patients because of liver diseases and/or biliary tract. Some of the patients with high treatment compliance strictly followed recommendations to take UDCA, and another part of the patients with low treatment compliance did not take UDCA. Comparison of these groups allowed highlighting UDCA effects.Results. Controlled lipid-lowering therapy in combination with UDCA resulted in a significant reduction in total cholesterol (TC) and low density lipoprotein cholesterol levels after 6 months of follow-up to 4.3 mmol/L and 2.3 mmol/L, respectively (pConclusion. One of the affordable and effective ways to deal with a wider statin use in patients with liver and biliary tract disorders is their co-administration with UDCA.

Aim. To provide final data on the three-year period of the inclusion of patients; to give most accurate "portrait" of patients hospitalized with a brain stroke within the framework of the LIS-2 register (Lyubertsy study of mortality in patients after stroke).Material and methods. All patients (n=960) admitted to the Lyubertsy district hospital №2 with stroke for the period from 01.2009 to 12.2011 were included into the study.Results. Men accounted for 37.5%, women - 62.5%, mean age was 71.1±9.8 years. The history of hypertension was present in 833 patients (86.8%), atrial fibrillation in 252 (26.8%) patients, 199 (20.7%) patients had previously undergone stroke. In-hospital mortality was 21.6% (207 patients had died; mean age 72.9±9.8 years). Low frequency of the antihypertensive therapy (34.5%), lipid-lowering therapy (0.7%), antiplatelet agents (5.7%), anticoagulation therapy prescription in patients with atrial fibrillation was detected.Conclusion. Insufficient assignment of drugs with a proven effect on the prognosis in patients with risk factors prior to the development of the reference stroke draws attention. High incidence of recurrent strokes indicates an underactive secondary prevention.

Aim. To develop a method for the assessment of quality of medical prevention of recurrent stroke and its’ testing using the results of the LIS-2 register (Lyubertsy study of mortality in patients after stroke).Material and methods. The scale evaluation of the quality of therapy for the prevention of recurrent stroke developed in accordance with the modern clinical practice guidelines, as well as the recurrent stroke prevention index (RSPI) for this assessment were elaborated. The analysis of the therapy was performed in patients after stroke in LIS-2 registers (n=219). The assessment of the quality of treatment was performed using RSPI, the influence of the index results on the in-hospital mortality was studied.Results. Two groups of patients [with RSPI=0 (n=137) and RSPI>0 (n=82)] were formed on the basis of the results evaluation via RSPI. Significant differences between groups were not found. At the same time higher in-hospital mortality (p=0.014; χ2 Pearson) was detected in patients with RSPI=0; relative risk of in-hospital death (after adjustment for sex and age) was 2.04 [1.07-3.91] (p=0.031). Analysis of the length of survival and duration of hospital stay was performed in both groups using the Kaplan-Meier method. In-hospital mortality was significantly higher in patients with RSPI=0, which was confirmed by the log-rank test (p=0.032).Conclusion. The results of the quality of medical care assessment in accordance with the developed method are significantly related to the outcomes during the stay in a hospital. The developed method, based on current clinical recommendations, can serve as an example of the implementation of evidence-based medicine in actual practice.

Aim. To study in the PROFILE register the rate of new oral anticoagulants (NOAC) taking in patients with atrial fibrillation (AF) and to identify the factors influencing it.Material and methods. Patients with AF who applied to the Cardiology Center in 2013-2014 (n=111) were included into the study. The oral anticoagulants (OAC) were recommended to patients at the reference visit (n=97). Inquiry in questionnaire format was performed to assess the compliance to recommended therapy at the follow-up visit. Patients were divided into two groups according to taking/not-taking NOAC. Analysis of the facts that influence the compliance to NOAC therapy was performed.Results. At the reference visit 70 patients desired to receive NOAC. At the follow-up visit 29 (41.4%) patients refused to take NOAC. Leading causes of NOAC refusal were satisfactory with warfarin (32.6%), the high price of these drugs (23.9%), the description of adverse reactions in the patient information leaflet for medicines (15.2%), and withdrawal by physician in outpatient clinic/hospital (8.7%). Preferential provision of medicines and warfarin therapy at the time of reference visit had a negative impact on the taking of NOAC. Patients taking NOAC were more aware of the possible outcomes of their illness, the possible side effects of OAC and were more familiar with patient information leaflet for medicines.Conclusion. The study assessed NOAC taking rate and the factors influencing patients' compliance to NOAC therapy.

Aim. To study the clinical equivalence of the two low-dose combined drugs on the base of generic and original bisoprolol and hydrochlorothiazide (HCTZ): BISANGIL® (Ozon, Russia) and LODOZ® (NYCOMED, Merck KGaA, Germany) in patients with arterial hypertension (HT) of 1-2 degrees.Material and methods. Patients with HT of 1-2 degrees (n=30; 11 men and 19 women; aged 62.7±10.7 years) were included in open crossover randomized trial. Duration of the study for each patient was 18 weeks: two 6-week courses of active treatment with each drug and two 2-week washout periods prior to each treatment course. The sequence of treatment courses was determined by randomization. Increase in bisoprolol dose and/or amlodipine addition occurred when effect was not sufficient. Therapy effectiveness (office blood pressure (BP), heart rate) and safety was monitored at visits.Results. BP reduction after 6 weeks of therapy was -21.6±11.1/10.4±11.3 mm Hg in LODOZ® group and -22.9±9.7/11.7±13.5 mm Hg in BISANGIL® group (pConclusion. The therapeutic equivalence of the studied fixed combinations of bisoprolol/HCTZ was demonstrated in treatment of patients with HT of 1-2 degrees.

Aim. Estimation of social, demographic and anamnestic characteristics of patients survived cerebral stroke as well as the medical treatment received by the patients before the reference stroke in the hospital and at discharge within the framework of the stroke register LIS-2 (study of mortality among patients survived stroke in Lyubertsy district).Material and methods. All the patients (637 persons) admitted to the Lyubertsy regional hospital №2 due to stroke from 01.01.2009 to 31.12.2010 were enrolled into the study.Results. 36% were men and 64% were women with mean age of 70.99Ѓ}9.6 years old. 554 (87.0%) patients had history of arterial hypertension and 155 (24.3%) – of atrial fibrillation.147 (23.1%) patients had previous stroke. In-hospital mortality made up 21.8% (mean age of 139 deceased patients was 72.7Ѓ}9.6 years old). 374 (75%) patients were prescribed ACE inhibitors, 421 (85%) - antiplatelet agents, 4 (1%) – warfarin. Statins intake was recommended to 3 (1%) patients. Conclusion. We revealed low frequency of prescription of drugs with proven positive prognostic value in patients after stroke.

Aim. To evaluate the differences between a group of patients treated with ursodeoxycholic acid (UDCA) during the study period and a group of patients not treated with UDCA by pseudo-randomization using Propensity Score Matching.Material and methods. 262 patients aged 60.1±8.9 years, taking statins for the secondary prevention of cardiovascular complications were included into a 6-month observational cohort study. The UDCA intake was recommended to all the patients due to the presence of liver and/or bile duct diseases. One part of the patients strictly followed medical recommendations and used UDCA, while the other part of the patients wasn’t taking UDCA. This allowed comparing the effect of UDCA in these groups.Results. Propensity Score Matching method allowed forming two groups of patients of 52 people each with similar main clinical and demographic characteristics. A more significant decrease in the levels of total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) (up to 4.0 mmol/L and 1.92 mmol/L, respectively; pConclusion. Combined therapy with statins and UDCA is effective and safe in patients with high cardiovascular risk and concomitant liver disease. Co-administration of statins with UDCA is promising in the treatment of hyperlipidemia in patients with low tolerance to statins. However, additional controlled studies are required.

Aim. To study the conformity of preventative therapy prescribed to patients during a hospital stay and at a discharge to clinical guidelines using a special algorithm, and to assess the impact of the results on a long-term mortality based on the LIS-2 register (Lyubertsy study of mortality in patients after cerebral stroke).Material and methods. The scales to assess the quality of cardiovascular care for the prevention of recurrent stroke along with the prevention of recurrent ischemic attacks index (PRIA index) for this assessment were developed according to current clinical guidelines. Analysis of the therapy was performed using PRIA index on survived hospital patients from LIS-2 register (N=753). The impact of PRIA index results on a long-term mortality (Me=2.3 years) was studied.Results. Based upon the results of the assessment obtained with PRIA index, higher treatment conformity to clinical guidelines resulted in a significantly better long-term survival. Non-conformity to clinical guidelines was due to the lack of prescription of drugs with proven efficacy and irrational choice of preventive therapy. Median of treatment quality assessment was 44.4% (22.2; 44.4).Conclusion. Low conformity of preventive therapy to clinical guidelines is found in the LIS-2 register. The algorithm for the assessment of preventive cardiovascular therapy quality allows identifying limitations in the prevention of recurrent stroke, and can serve as an example of implementation of evidence-based medicine in clinical practice.