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

The coronavirus disease 2019 (COVID-19) pandemic has shown the need for the development of telemedicine technologies, especially remote follow-up using vital sign telemonitoring. In the Russian Federation, this approach is also justified by the remoteness factor with a shortage of medical workers in distant areas of the country.Aim. To study the potential of remote monitoring in outpatients discharged after acute decompensated heart failure and acute coronary syndrome.Material and methods. The study included 392 patients randomized to active follow-up groups with remote blood pressure (BP) monitoring (group 1, n=197) and standard management (group 2, n=195). The follow-up period lasted 3 months.Results. During the follow-up period, patients managed with BP and heart rate telemonitoring tended to decrease in systolic BP from 132 (interquartile range (IQR), 121-139) mm Hg up to 125 (IQR, 115-130) mm Hg (p=ns). On the contrary, the 2nd group patients had a slight increase in systolic BP from 127 (IQR, 115-137) mm Hg up to 132 (IQR, 124-142) mm Hg (p=ns).The patients of group 2 were more likely to receive diuretics and nitrates after 3-month follow-up, which can be considered a negative factor. This may indicate no improvement in the course of heart failure and chronic coronary artery disease with the absence of therapy correction over time.During follow-up, four patients from group 1 were hospitalized due to decompensated heart failure or an episode of acute coronary syndrome with a total duration of 30 days, compared with 13 hospitalizations for the same reasons in group 2 (p=0,027; OR 3,4; 95% CI 1,1-10,8). In total, six patients died during the follow-up period in group 1, and eleven patients died in group 2 (p=0,226; OR 1,9; 95% CI 0,7-5,3). At the same time, three patients in the 1st group and one patient from the 2nd group died during the follow-up period due to COVID-19. Thus, cardiovascular mortality consisted of 3 and 10 patients in groups 1 and 2, respectively (p=0,052; OR 3,5; 95% CI 0,9-12,9).Conclusion. Three-month remote management of patients after decompensated heart failure or acute coronary syndrome, including BP monitoring, showed a significant reduction in the hospitalization rate and a trend towards a decrease in cardiovascular mortality.

The article presents a literature review on the application of digital twin technology in healthcare administration over the past decade. This review examines the potential applications of digital twins at different levels of healthcare management. The formation and global development of digital twin technology are discussed. Examples of the use of digital twins in the management of healthcare institutions and healthcare processes are specified, and their advantages and future prospects are analyzed.

The article provides an overview of new and promising drugs aimed at anti-inflammatory and urate-lowering therapy of gout, both already registered and used in clinical practice, and at the stages of implementation or clinical research and demonstrating their high efficacy and safety. Modern views and approaches to the treatment of gout, reflected in foreign and domestic clinical recommendations, are shown. Emphasis is placed on the safety and efficacy of colchicine in gouty arthritis and its cardioprotective properties in comorbid patients suffering from gout in combination with cardiovascular pathology. Information is provided on the effectiveness of new anti-inflammatory drugs for symptomatic therapy of gout: kanakinumab, according to the experience of which our country occupies a leading position in Europe. The efficacy and safety of anakinra allows us to consider the drug as an effective alternative to the traditional approach to antiinflammatory therapy of gout. Rilonacept provides doctors with more potential treatment algorithms in a population of patients with gout that is difficult to treat with traditional treatment. The historical data on the use of adrenocorticotropic hormone as an anti-inflammatory agent in gout are given. Information on reserve, new and promising urate-lowering drugs is provided. The focus is on the safety and efficacy of febuxostat, based on the results of recent large randomized clinical trials. Other drugs that reduce the level of uric acid in the blood plasma are considered: uricosuric agents (probenecid, benzbromarone, sulfinpyrazone, lezinurad, verinurad, dotinurad and archalophenate), xanthine oxidase inhibitors (allopurinol and topiroxostat), pegylated uricase preparations (pegloticase and rasburicase), which can be considered in the future as reserve drugs with the possibility of combined applications with the main means for urate-lowering therapy.