Search

The research represents data on dispersing dosage form of Coversyl adherence and efficacy in real clinical practice.

Aim. To present data from the AURA Registry (real-world data registry on AlbUminuRia detection rate among patients with previously undiAgnosed chronic kidney disease). It is important to perform population studies both to study the occurrence of markers (albuminuria (AU), decreased glomerular filtration rate (GFR)) and the prevalence of chronic kidney disease (CKD), which will provide information on the actual detection rate of CKD and the related markers in territories included in the registry of research centers.Material and methods. The article presents the first data from the AURA registry. Recruitment was carried out from March 6, 2023 to January 23, 2024. Thirty-four research centers in various federal districts of the Russian Federation and 104 doctors took part in the recruitment. We included 4580 subjects over the age of 40 years who had no previously established diagnosis of CKD and did not have type 1 or type 2 diabetes. During recruitment, the researchers were guided by the AURA study protocol (Version 1.7/12-26-2022).Results. AU more than 20 mg/g was detected in 64,9% of cases. At the same time, AU is more common at GFR values that may correspond to stage 3A of CKD. The rarer occurrence of AU in those examined with GFR >60 ml/min/1,73 m2 may be explained by less severe renal damage at this CKD stage. The incidence of AU was significantly higher in men, older people, smokers, people with metabolic syndrome, hypertension (HTN), prediabetes and overweight. The occurrence of AU also increased as HTN grade increased. AU detection rate was associated with hypertriglyceridemia, a high blood level of C-reactive protein, which is an integrative marker of inflammation that negatively affects cardiovascular risk.Conclusion. The presented first data from the AURA registry demonstrated the high AU prevalence in people over 40 years of age. A high incidence of AU was typical for patients with HTN, coronary artery disease, atrial fibrillation, heart failure, and prediabetes. An association has been demonstrated between the high incidence of AU and male sex, age, overweight, hyperuricemia, dyslipidemia, and a number of other cardiovascular risk factors.

Aim. To analyze newly diagnosed diseases and features of the post-COVID course in patients after a coronavirus disease 2019 (COVID-19) within 12-month follow-up.Material and methods. A total of 9364 consecutively hospitalized patients were included in the ACTIV registry. Enrollment of patients began on June 29, 2020, and was completed on March 30, 2021, corresponding to the first and second waves of the pandemic. Demographic, clinical, and laboratory data, computed tomography (CT) results, information about inhospital clinical course and complications of COVID-19 during hospitalization were extracted from electronic health records using a standardized data collection form. The design included follow-up telephone interviews with a standard questionnaire at 3, 6, and 12 months to examine the course of post-COVID period.Results. According to the ACTIV registry, 18,1% of patients after COVID-19 had newly diagnosed diseases (NDDs) over the next 12 months. Hypertension (HTN), type 2 diabetes and coronary artery disease (CAD) prevailed in the NDD structure. Comparison of the age-standardized incidence of NDDs (HTN, CAD, diabetes) in the post-COVID period in the ACTIV registry with NDD incidence in 2019 according to Rosstat and the expected incidence of NDDs according to the EPOHA study revealed that HTN, diabetes, CAD in patients after COVID-19 were registered more often as follows: HTN by 7,0 and 4,4 times, diabetes by 7,3 and 8,8 times, CAD by 2,3 and 2,9 times, respectively. NDDs most often developed in patients aged 47 to 70 years. Comparison of the actual and expected number of cases of newly diagnosed HTN, CAD and diabetes depending on age showed that the actual number of cases in the population of patients in the ACTIV register is significantly higher than expected for patients aged 45-69 years and for patients with hypertension or diabetes and aged

Russian Society of Cardiology (RSC)With the participation of the Eurasian Association of Therapists, the Russian Scientific Medical Society of Therapists (RNMOT), the Russian Society of Pathologists, the Russian Society of Radiologists and Radiologists (RSR)Approved by the Scientific and Practical Council of the Russian Ministry of Health (30.09.2022)

Aim. To study cardiovascular risk factors, clinical manifestations and management of myocardial infarction (MI) in elderly and long­living patients depending on geriatric status.Material and methods. Out of 92 patients with MI (mean age, 81,6±4,2), 3 following groups were formed: "frailty" — 35 (38,0%), "prefrailty" — 16 (17,4%), and "no frailty" — 41 (44,6%). The following questionnaires were used: Age Is Not a Hindrance, Mini Nutritional Assessment (MNA), Barthel Index for Activities of Daily Living, Lawton Instrumental Activities of Daily Living Scale, balance test, Gait Speed Test, Timed Up and Go test, grip test, Mini Mental State Examination (MMSE), Clock Drawing Test, Geriatric Depression Scale.Results. Frailty probability in patients is higher in the presence of obesity, type 2 diabetes, a decrease in glomerular filtration rate (GFR)

Aim. To investigate on post-COVID period in patients of the Eurasian region.Material and methods. A total of 9364 consecutively hospitalized patients were included in ACTIV registry. Enrollment of patients began on June 29, 2020, and was completed on March 30, 2021, corresponding to the first and second waves of the pandemic. Demographic, clinical, and laboratory data, computed tomography (CT) results, information about inhospital clinical course and complications of COVID-19 during hospitalization were extracted from electronic health records using a standardized data collection form. The design included follow-up telephone interviews with a standard questionnaire at 3, 6, and 12 months to examine the course of post-COVID period.Results. According to ACTIV register, 63% of patients after COVID-19 had new adverse symptoms or exacerbations of the existing symptoms lasting for up to 1 year. After hospital discharge, 79,8% of patients sought unscheduled medical attention in the first 3 months, 79,1% at 4-6 months, and 64,8% at 7-12 months. Readmission rate was 11,8% in the first 3 months, 10,9% at 4-6 months, and 10,1% at 7-12 months. The most common reasons for unscheduled treatment in the first 3 months were uncontrolled hypertension, decompensated type 2 diabetes, destabilization of coronary artery disease, gastrointestinal disease, AF episodes, exacerbation of asthma and chronic obstructive pulmonary disease, decompensated heart failure (HF). The 12-month mortality of COVID-19 survivors after the discharge was 3,08%. Multivariate analysis showed that independent risk factors for fatal outcome were age (direct correlation), the levels of hemoglobin (inverse correlation), oxygen saturation (inverse correlation), and aspartate aminotransferase (direct correlation), as well as class III-IV HF, prior stroke, cancer, inhospital acute kidney injury. Based on these identified risk factors, a nomogram was constructed to determine the 3-month mortality risk after discharge.Conclusion. Analysis of ACTIV register showed that end of the acute phase of COVID-19 does not imply a complete recovery.

Aim. To study the lipid profile in hospitalized patients with coronavirus disease 2019 (COVID-19) depending on the outcome of its acute phase according to the AKTIV international registry.Material and methods. The AKTIV registry included men and women over 18 years of age with a diagnosis of COVID-19, who were treated in a hospital. A total of 9364 patients were included in the registry, of which 623 patients were analyzed for levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides on days 1-2 of hospitalization. The level of high-density lipoprotein cholesterol (HDL-C) was calculated using the Friedewald equation.Results. We found that a decrease in LDL-C level was significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. This pattern persisted in both univariate and multivariate analyses. LDL-C levels in the final multivariate model had a significant relationship with the prognosis (an increase in the death risk by 1,7 times with a decrease per 1 mmol/l). In addition, we found that the survival of patients with an indicator level of

Aim. To evaluate clinical-economical effectiveness of direct oral anticoagulants (DOAC) dabigatran, rivaroxaban, and apixaban in comparison with warfarin in atrial fibrillation (AF) therapy.Materials and Methods. Mathematical modeling (tree derivation of solutions) on a temporary 5-year horizon from the medical healthcare system perspective. Methods of clinical-economic analysis: analysis “cost-effectiveness”, “budget impact”, and “the analysis of unseized opportunities”.Results. Total direct costs (DC) were lower by 10.3% when dabigatran was used, by 5.2%, when rivaroxaban was used, and by 10.9%, when apixaban was used in comparison with warfarin. The most significant difference was observed due to different cost of therapy for bleeding complications (in the structure of the costs, it occupied 30-38%). In the group of dabigatran, DC on bleeding complications were lower than in the group of warfarin by 22.0%, in the group of rivaroxaban – by 10.9%, in the group of apixaban – by 36.8%. Besides, in the group of dabigatran, the costs associated with the treatment for ischemic stroke were lower by 28.1% The strategy of the application of DOAC in comparison with warfarin provided more adjusted life years (ALY), complications adjusted life years (CALY), and its lower cost. The application of DOAC saves significant funds. At the same time, the saved funds will provide the purchase of additional modern drugs for patients. The cost-cutting reaches 12% for 5 years and up to 33 patients out of 1000 can receive additional treatment.Conclusion. Due to the prevention of thromboembolic complications in patients that received direct oral anticoagulants, the direct costs can be reduced by 28.1% and due to the prevention of bleeding complications – by 36.8% in comparison with the application of warfarin. Direct oral anticoagulants provide more adjusted life years and complications adjusted life years at a lower cost.

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period.

Objective: to analyze whether comorbidity affects the cost of treatment and medical services in elderly patients with atrial fibrillation (AF). Materials and methods. We conducted a retrospective analysis of 98 patients with AF. Comorbidity was evaluated using the CIRS-G scale (Cumulative Illness Rating Scale for Geriatrics) and the Charlson criterion. The “cost of illness” calculations included direct costs only. Results. In elderly patients with AF (mean age 74.7±8.8 years), high rate of comorbidity was typically found. Charlson comorbidity index amounted to 4.0±1.8, and the CIRS-G score – to 8.0±2.8. AF is often associated with heart diseases such as hypertension – 98.9%, coronary heart disease – 27.6%, and congestive heart failure – 76.5%. A patient with AF received on average 7.5±3.8 medications. Direct costs amounted to 18298.2±9440.4 RUB per patient with AF per year. Of this amount, 78.8% were spent for outpatient treatment, 16.5% for hospitalization and 4.7% for ambulance service. Cardiac medications comprised 66.4% of the total direct costs. In patients with high comorbidity, there are high costs of treatment of concomitant diseases, high secondary costs as well as costs for a doctor visit. Conclusion. An average elderly patient with AF receives 7.5±3.8 permanent medications, which correlates with the severity of comorbidity by the Charlson index (r=0.59; p=0.000) and the CIRS-G score (r=0.29; p=0.004). Management of such patients at the outpatient clinic is by large (66.4%) associated with direct costs of the prescribed medications. However, patients with high comorbidity still need more vital drugs, as the cost of treatment of concomitant diseases increases. Notably, these patients spend 4 times more funds for drugs without proven efficacy.

The international AKTIV register presents a detailed description of out- and inpatients with COVID-19 in the Eurasian region. It was found that hospitalized patients had more comorbidities. In addition, these patients were older and there were more men than among outpatients. Among the traditional risk factors, obesity and hypertension had a significant negative effect on prognosis, which was more significant for patients 60 years of age and older. Among comorbidities, CVDs had the maximum negative effect on prognosis, and this effect was more significant for patients 60 years of age and older. Among other comorbidities, type 2 and 1 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cancer and anemia had a negative impact on the prognosis. This effect was also more significant (with the exception of type 1 diabetes) for patients 60 years and older. The death risk in patients with COVID-19 depended on the severity and type of multimorbidity. Clusters of diseases typical for deceased patients were identified and their impact on prognosis was determined. The most unfavorable was a cluster of 4 diseases, including hypertension, coronary artery disease, heart failure, and diabetes mellitus. The data obtained should be taken into account when planning measures for prevention (vaccination priority groups), treatment and rehabilitation of COVID-19 survivors.

The organizer of the registers “Dynamics analysis of comorbidities in SARSCoV-2 survivors” (AKTIV) and “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2) is the Eurasian Association of Therapists (EAT). Currently, there are no clinical registries in the Eurasian region designed to collect and analyze information on long-term outcomes of COVID-19 survivors with comorbid conditions. The aim of the register is to assess the impact of a novel coronavirus infection on long-term course of chronic non-communicable diseases 3, 6, 12 months after recovery, as well as to obtain information on the effect of comorbidity on the severity of COVID-19. Analysis of hospitalized patients of a possible second wave is planned for register “AKTIV 2”. To achieve this goal, the register will include men and women over 18 years of age diagnosed with COVID-19 who are treated in a hospital or in outpatient basis. The register includes 25 centers in 5 federal districts of the Russian Federation, centers in the Republic of Armenia, the Republic of Kazakhstan, the Republic of Kyrgyzstan, the Republic of Belarus, the Republic of Moldova, and the Republic of Uzbekistan. The estimated capacity of the register is 5400 patients.

COVID-19 is a severe infection with high mortality. The concept of the disease has been shaped to a greater extent on the basis of large registers from the USA, Spain, Italy, and China. However, there is no information on the disease characteristics in Caucasian patients.Therefore, we created an international register with the estimated capacity of 5,000 patients — Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (AKTIV SARS-CoV-2), which brought together professionals from the Russian Federation, Republic of Armenia, Republic of Kazakhstan, and Kyrgyz Republic. The article presents the first analysis of the register involving 1,003 patients. It was shown that the most significant difference of the Caucasian population was the higher effect of multimorbidity on the mortality risk vs other registers. More pronounced effect on mortality of such diseases as diabetes, obesity, hypertension, chronic kidney disease, and age over 60 years was also revealed.

Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic

Experts consensus of the Russian Cardiology Society (RSC)

Objective. To determine the priority used to vital drugs in сhronic obstructive pulmonary disease (COPD) patients in hospitals of the Kirov region.Materials and Methods. We analyzed 143 medical records of the patient, the analysis of cost of illness, ABC\ VEN — analysis.Results. The results of АВС analysis show that the percentage correlation of medicines of different groups generally corresponds to the recommended norm. The results of VEN analysis prove that the number of vital drugs is decreased while the number of second line drugs is increased.Conclusion. Most of the financial costs were for the treatment of exacerbations of COPD, the appropriate Federal clinical guidelines, simultaneously, there is an active assignment of the second line drugs. Reducing their use and rational therapy of acute conditions will enable competently reallocate financial resources in favour of vital drugs to increase the effectiveness of treatment and reduce the cost of inpatient care.

Atrial fibrillation is a serious social and health problems, the most common arrhythmia in practice, leading to an increased risk of death, stroke, heart failure. The results of pharmacoeconomical studies allow to evaluate the quality of drug therapy for atrial fibrillation, find rational drug usage and identify ways to optimize the consumption of medications. The objective of investigation is to hold ABC-, VENand frequency analysis of atrial fibrillation in out-patients to assess their compliance with national and international recommendations. Materials and methods. To analyze the treatment of atrial fibrillation 98 outpatients with atrial fibrillation were randomly selected. Every patient appealed to the reception to the physician at least twice in 2013. The data was recorded in a special card, and then analyzed using ABC-, VENand frequency analysis. Results. For the treatment of patients with different forms of atrial fibrillation has been used 114 types of drugs to the INN. Patients received from 3 to 12 drugs. For the treatment of patient with atrial fibrillation it spends an average of 11245.2 rubles per patient, for the treatment of heart disease it spends 8379.51 rubles., that is about 74.5%. The study found that received data is satisfied modern recommendations. The results of frequency analysis showed that the most prescribed drugs are medications with proven efficacy to the quality and duration of life. Conclusions. Data analysis revealed that the percentage volume of drugs between the groups as a whole corresponds to the recommended distribution of drugs.

Aim. To perform the comparative cost-efficacy analysis of various antihypertensive therapies in hypertensives patients.Material and methods. 140 hypertensive patients with history of ineffective antihypertensive therapy were randomized in to 4 groups, 35 patients in each one. Patients of Group A received indapamide retard plus perindopril; group B - indapamide retard plus amlodipine; group C - amlodipine plus lisinopril; group D - amlodipine plus bisoprolol. The Russian version of general questionnaire MOS-SF-36 was applied for quality of a life estimated. Endothelium function was evaluated with B-mode ultrasonography (Acuson 128 ХР/10). Albuminuria level was detected by immunoturbometric method (Integra-700, Roche).Results. The drug combination B had the least cost. The drug combination C was the most effective. The drug combination C was the most economically rational. The drug combination A was the least economically rational for BP reduction. However the drug combination A was comparable with drug combination C in effects on quality of life and on endothelium function, and it was the most economically rational for albuminuria reduction.Conclusion. Indapamide retard plus perindopril combination is the most economically rational in patients with target-organ lesions (nephropathy). Lisinopril plus amlodipine combination is economically rational in patients without target-organ lesions.

Aim. To compare tolerability of various antihypertensive combinations in patients with arterial hypertension (HT).Material and methods. 140 patients with HT with history of non-effective antihypertensive therapy were randomized in 4 groups, 35 patients in each. Patients of group A received indapamide retard/perindopril; group B - indapamide retard/amlodipine; group C – amlodipine/lisinopril; group D – amlodipine/bisoprolol. Therapy duration was 12 weeks.Results. 28 (20%) patients dropped out of the study. All antihypertensive combinations significantly decreased blood pressure level. Patients of group A did not stop therapy because of adverse events. 6 (17,1%) dropped out of the study because of ineffective therapy in maximal doses and therapy rejection. Palpitation was a reason of drug withdrawal in 3 (8,6%) of 8 (22,9%) dropped patients of group B. Low limb edema was a reason of drug withdrawal in 4 (11,4%) of 8 (22,9%) dropped patients of group D. Cough was a reason of drug withdrawal in 4 (11,4%) of 5 dropped patients of group C. Dose reduction was needed in some patients of all groups because of hypotension.Conclusion. The adverse events were observed in 25% of patients during 12 weeks of therapy. The patients received indapamide retard/amlodipine and amlodipine/bisoprolol had the highest rate of drug withdrawal because of adverse events. Low limb edema, cough and palpitation were the most frequent adverse events needed therapy withdrawal.

Aim. To study effects of fixed combination of valsartan and amlodipine on of left ventricular hypertrophy (LVH) regression, microalbuminuria reduction and endothelium function in hypertensive patients with metabolic syndrome (MS).Materials and methods. 20 hypertensive patients (15 females and 5 males) with metabolic syndrome and a history of previous ineffective antihypertensive therapy were studied. Combined antihypertensive therapy was applied during 12-24 weeks. Amlodipine and valsartan dose was 5/160 or 10/160 mg/day depending on blood pressure level. Endothelial function, blood pressure level, urinary albumin excretion and LVH regression were estimated.Results. Blood pressure reduction to the target level was revealed. There was a significant reduction in microalbuminuria by -55.3±39.2% (р=0.022) in comparison with the baseline. Endothelium-dependent vasodilation increased in 3.6±7.2% (р=0.05) in comparison with baseline, LVH decreased by -9.1±12.4 g/m2 (р=0.021).Conclusion. Therapy with fixed combination of valsartan and amlodipine results in blood pressure and microalbuminuria reduction, endothelium-dependent vasodilation improvement, LVH regression in hypertensive patients with MS. These findings show that the fixed combination of these antihypertensives has a multifaceted impact on cardiovascular risk.

Aim. To carry out a comparative pharmacoeconomic analysis of two different types of antihypertensive therapy in patients with arterial hypertension (HT). Material and methods. 38 patients with essential HT (aged 18 to 70 years, 11 males and 27 females) associated with metabolic syndrome, and having a history of previous ineffective antihypertensive therapy were included into the study. The patients were randomized into 2 groups. Patients of V/A group received a fixed combination of valsartan and amlodipine (Exforge, Novartis) in dose of 5/160 and 10/160 mg depending on blood pressure (BP) level. Patients of L/A group received losartan (Lorista, KRKA) in dose of 100 mg and amlodipine (Tenox, KRKA) in dose of 5 and 10 mg. Treatment duration was 24 weeks. If target level of BP was not achieved during 12 weeks, indapamide retard was added to the therapies (Ravel SR, KRKA). Dinamics of BP and left ventricular mass index (LVMI) were considered. Cost-effectiveness method of analysis was used. Results. In V/A group 75% of patients achieved target BP levels for 24 weeks, while in L/A group — 33.3% of patients, and 16.7% of patients more after indapamide addition. L/A therapy cost was lower in comparison with this of V/A therapy: 57864.24 vs 156671.0 rubles per 24 weeks, respectively. Calculation shows that additional cost of 669.23 rubles during 24 weeks is needed to achieve BP target level in every next patient when V/A therapy is used instead of L/A therapy. LVMI reduction by 1% took 1015.13 rubles cost in V/A group and almost 6 times more in L/A group. Conclusion. Pharmacoeconomic analysis revealed that generic combination of L/A is the most cost-effective for BP reduction. Very low cost is required to achieve additional effect with original fixed V/A combination. V/A combination is the most economical for the left ventricular hypertrophy reduction. Thus, V/A combination is rational for use in HT patients with severe target-organs damage.

Aim. To evaluate the economic effectiveness of the combined two-drug antihypertensive therapy in patients with arterial hypertension (HT) and high cardiovascular risk by Markov’s modeling.Material and methods. Patients (n= 65; 19 males and 46 females) with essential HT accompanied by metabolic disorders, history of previous ineffective antihypertensive therapy were included into the study. Patients were randomized into 2 groups. Group V/A was treated with valsartan and amlodipine in fixed-dose combinations of 160/5 and 160/10 mg depending on blood pressure (BP) level. Patients of group L/A were treated with losartan 100 mg and amlodipine 5 or 10 mg daily. Treatment duration was 24 weeks. Changes in BP level, and left ventricular hypertrophy (LVH) regression were assessed. Economic evaluation was performed on the basis of modeling with specialized software Decision Tree 4.xla.Results. Effect of the two variants of combination therapy on LVH was used to estimate treatment effectiveness and to build the model. Patients were distributed according to the left ventricular mass (LVM) at baseline and after 24 weeks of therapy. Significant decrease in LVM was observed in V/A group: from 225.1±71.7 to 186.3±44.5 g (pConclusion. Treatment with V/A fixed-dose combinations shows higher antihypertensive and cardioprotective efficacy in comparison with that in L/A combination therapy. It reduces a risk of acute myocardial infarction, stroke and death more effectively. V/A therapy gains the maximal number of life years and QALY due to LVM regression.L/A combination is the most cost-effective in terms of cost of life year gained and QALY. L/A combination allows to save costs due to lower cost of treatment.

Aim. To study therapeutic equivalence of rosuvastatin generic and original medication and to conduct the pharmacoeconomic analysis to compare the impact of the drug on direct expenses in secondary prevention for the patients with chronic ischemic heart disease (CHD). Material and methods. The open label, prospective observational study performed with the switch of medication, that included 38 patients with chronic CHD and duration of 6 months. During 3 months the patients received original drug rosuvastatin Crestor 10-20 mg, leading to the target level of low density cholesterol

In the course of work 143 medical inpatient cards were studied by a method of retrospective pharmacoepidemiologic analysis for their compliance with national recommendations and standards. Only 47.5% of patients receive the recommended basic therapy. The most common mistakes: insufficient broncholytic therapy, prescription of iGCS if there are no indications for them; excessive use of antibacterial drugs; use of irrationally lowered dosages of sGCS. The obtained results are indicative of the fact that for the purposes of increase of the therapy effectiveness educational programs on therapy of COPD for doctors of inpatient clinics as well as administrative control of implementation of federal clinical recommendations on COPD are required.

Aim. То compare the effects of different two-component antihypertensive therapy (AHT) variants on endothelial dysfunction (ED) and albuminuria (AU) in patients with arterial hypertension (AH).Material and methods. The study included 140 AH patients (mean age 57,0±8,9 years): 28,6 % men and 71,4 % women. Inclusion criterion was ineffective AHT in anamnesis. Endothelial function (EF) was assessed by ultrasound, AU — by turbidimetry, and glomerular filtration rate (GFR) — by MDRD formula. All participants were randomised into 4 groups, containing 35 persons each. The treatment phase lasted for 12 weeks.Results. Most AH patients demonstrated ED symptoms, including paradox vasoconstriction. The most severe ED variants were observed in patients with diabetes mellitus. A significant reduction in blood pressure level was achieved in all groups, while АНТ benefits for EF were observed only in Groups A, В and C. Comparing to Group D, perindopril combination more effectively reduced AU. A small, but significant increase in GFR was achieved in patients receiving lisinopril and amlodipine. The combination of bisoprolol and amlodipine did not show any significant effects on ED and AU.Conclusion. Twelve-week combined АНТ (perindopril + indapamide retard, amlodipine + indapamide retard, lisinopril + amlodipine) was associated with significantly improved EF. The most effective combinations included ACE inhibitors. The combination of bisoprolol and amlodipine was not effective in patients with reduced GFR and microalbuminuria, as it did not improve EF.

β-Adrenosensitizing activity of blood serum diluted by 50-, 100-, 500-, 1000- и 10000, from 10 almost healthy elderly people and 40 patients with acute coronary event (ACE), was studied on longitudinal strips of uterine horns of 31 rats. 10 of them underwent physical exercising during rehabilitation, thus increasing working capacity and left ventricle contractility. Serum from normal subjects showed no β-adrenosensitizing activity, i.e. contained no endogenous blockers of β-receptors. In patients with ACE including those performing physical exercise, all serum dilutions, particularly 500- and 1000-fold, increased the inhibiting effect of epinephrine (10-8 g/ml) which is explained by the presence of endogenous β-receptor sensitizers (EBRS) - like, probably, histidine, tryptophan and tyrosine. In ACE β-adrenosensitizing activity and, therefore, the EBRS level, is below the values in normal subjects, increasing in physical exercise. An opportunity of increasing the effectiveness of β-activity upon heart and vessels during rehabilitation following an ACE, and by using aromatic aminoacids and drugs (Preductal or Mildronate) is discussed.

The adherence to a low-phosphate diet in the daily life of dialysis patients was evaluated. The study included 102 patients on renal replacement therapy with programmed hemodialysis. According to the survey, analysis of adherence to a low-phosphate diet by patients was performed. The main causes of non-compliance of patients with low phosphate diets were identified. It was revealed that patients on renal replacement therapy with programmed hemodialysis do not stick to the low-phosphate diet to full extent.

Objective: to study the clinical and economic benefits of adding ivabradine to standard therapy for chronic heart failure (CHF). Subjects and methods. A clinical and economic analysis of the pharmacoeconomic efficacy of ivabradine (Coraxan Servier, France) in patients with CHF was made using the Markov simulation on the basis of the SHIFT trial. The cost-utility ratio (CUR) was calculated by the formula: CUR=DC/Ut, where DC is the direct cost of treatment; Ut is the cost utility expressed in life-years gained (LYG) and quality-adjusted life years (QALY). While calculating the latter, the model used the utility value derived in the SHIFT-PRO trial, by applying the EQ-5D questionnaire. Results. The monthly cost of standard pharmacotherapy was 799,14 rbl. per person. The treatment involving ivabradine cost 1807,77 rbl. The mean total direct cost for treating one patient was 64 741,09 and 47 647,83 rbl. in the ivabradine and placebo groups, respectively. The costs of hospital stay were ascertained to constitute 60% of all the direct costs in patients receiving standard therapy. On the contrary, addition of ivabradine to standard therapy allows avoidance of 309 admissions for worsening CHF, which permitted 23 709 879 rbl. to be saved. Reducing the costs of hospitalization enables one to spend 67% of the means for pharmacotherapy. Following a 10-year simulation period, the standard therapy remains more inexpensive than therapy involving ivabradine (74 585,31 rbl. per person versus 120 843,30 rbl per person) and ensures the lower cost of one LYG and one QALY. At the same time, the therapy added by ivabradine can prevent 1300 admissions for CHF and about 500 deaths per 10,000 patients over 10 years. This will lead to more life-years gained (4,277 LYGs on ivabradine therapy versus 4,083 LYGs on standard therapy), including quality-adjusted life years (3,031 QALYs on ivabradine therapy versus 2,839 QALYs on standard therapy). When ivabradine was added to standard therapy, the cost of one LYG was 238 443 rbl. and that of QALY was 240 927 rbl. Thus, the estimated medical intervention is a cost-effective investment. Conclusions: 1. To enhance the efficiency of CHF treatment with ivabradine causes a rational change in the cost structure. 2. To reduce the costs of hospitalizations and to change the cost structure provide a possibility of increasing those of qualitative therapy. 3. To incorporate ivabradine in therapy for systolic CHF can gain more additional life years, including quality-adjusted life years. 4. To increase expenses on therapy involving ivabradine per LYG is a cost-effective investment.