Aim. To assess the healthcare system costs for the management of patients with heart failure (HF) based on a retrospective analysis of primary medical documentation.Material and methods. We performed the analysis of outpatient records of 1000 patients, followed up for 1 year by a general practitioner or cardiologist in ambulatory clinic in 7 Russian regions. The study included men and women over 18 years of age with an established class II-IV HF and at least one hospitalization due to acute decompensated HF within 12-month follow-up.Results. The final analysis included 888 patients (men, 52,9%; women, 47,1%; mean age, 69 [61; 78] years). The preserved ejection fraction (EF) was detected in 47,86% of patients, mid-range — in 40,54%, reduced — in 11,6%. Only in 16% of patients, there was improved by 1 or more HF. Hypertension and coronary artery disease were predominant in etiology pattern of HF. Preserved EF was more often detected in women over 60 years of age, with HTN and obesity, as well as with HF with mid-range and reduced EF in men in the same age group. There was sufficient follow-up rate, but the extent examinations do not correspond to the recommended one. The prescription rate of renin-angiotensin-aldosterone system (RAAS) inhibitors corresponds to the recommended one, but there is a high frequency of prescribing angiotensin II receptor blockers (ARBs). The prescription rate of β-blockers and loop diuretics (mainly torasemide) increased in comparison with previous studies, while thiazide diuretics — decreased. In patients with reduced EF, the prescription rate of sacubitril/valsartan was only 14,7%, β-blockers — 83,3%, mineralocorticoid receptor antagonists (MCRA) — 72,5%. In patients with midrange EF, there was a sharp decrease in prescription rate of RAAS inhibitors, β-blockers, MCRA.Conclusion. The practical follow-up of patients with HF differs significantly from clinical guidelines. Due to inadequate pharmacotherapy, as well as insufficient noncompliance with the recommended extent of investigations, 1-year HF therapy does not lead to a pronounced improvement in the patients' class.

Генетические предикторы пятилетних исходов перенесенного острого коронарного синдрома

In a pandemic, a special group is made up of patients with cardiovascular pathology. Cardiovascular diseases are largely associated with an increase in mortality and an increased risk of complications in patients infected with the SARS-CoV-2 virus. This determines the importance of risk stratification, the choice of optimal personalized therapy and the study of the long-term prognosis of myocardial infarction against the background of infection caused by SARS-CoV-2. Despite the rapidly growing attention to this issue, the mechanisms of the relationship between cardiovascular disease and COVID-19 are not completely clear. We conducted a systematic review to summarize important aspects of COVID-19 for cardiologists. The authors discuss both well-studied factors of the infectious process leading to acute myocardial damage and decompensation of existing chronic cardiac diseases, and new, fundamental, determining prognosis and treatment. Information on the topic was used from publications based on the PubMed, Google Scholar and eLibrary.ru databases. This work was carried out within the framework of a research grant № 67573613 of Pfizer.

The aim of the study is to evaluate the association of some molecular genetic markers with progressive atherosclerosis.Material and methods. In total, the study included 202 patients (147 men and 55 women), who were divided into 2 groups. The 1st (main) group included patients with coronary artery disease (100 people) who had a combination of two or more cardiovascular events during the last 2 years before inclusion: myocardial infarction or unstable angina pectoris, arterial stenting for urgent indications (coronary and peripheral), stroke; acute ischemia, thrombosis or amputation of the lower extremities. The 2nd group (comparisons) included 102 patients with coronary artery disease who did not have any of the above cardiovascular events during the last 2 years before inclusion. DNA was isolated from peripheral blood samples by phenol-chloroform extraction.Results. In the group with progressive atherosclerosis at the age of 55 years and older, the AA rs3746444 genotype of the MIR499A gene was absent in both men and women, while in the control group its frequency reached 8.3 % (p = 0.044). The odds ratio of detecting the carriage of the heterozygous genotype AG of the rs6922269 polymorphism of the MTHFD1L gene in the group with progressive atherosclerosis is 0.5 times lower compared to the control group (95 % confidence interval 0.3–0.9; p = 0.034).Conclusions. Carrying the AA genotype rs3746444 of the MIR499A gene is a conditionally protective factor against the development of progressive atherosclerosis at the age of 55 years and older. Carrying the AG genotype of the rs6922269 polymorphism of the MTHFD1L gene is associated with a reduced likelihood of developing progressive atherosclerosis in patients with CAD.

Aim. To assess the healthcare system costs for the management of patients with heart failure (HF) based on a retrospective analysis of primary medical documentation.Material and methods. We performed the analysis of outpatient records of 1000 patients, followed up for 1 year by a general practitioner or cardiologist in ambulatory clinic in 7 Russian regions. The assessment of the HF socioeconomic burden was carried out from the perspective of the state. A bottom-up approach was applied to the cost analysis. To calculate the average costs per patient per year, the costs for each patient were calculated, followed by estimation for the entire cohort. Direct costs (medical: outpatient care, inpatient care, drug therapy; nonmedical: disability pensions and temporary disability) and indirect costs (loss of gross domestic product) were estimated.Results. It was shown that the average cost of managing 1 HF patient is RUB 160338 per year. The cost of drug therapy varied significantly depending on the source of funding. So, the total therapy cost was about RUB 90000 per year, while within the drug assistance programs — about RUB 7000 per year. Thus, the proportion of drug therapy in cost pattern per patient from the state’s perspective was only 4,7%, while the maximum costs were for inpatient care (45,5%), stay in intensive care units (16,4%) and disability payments (21,6%). The direct costs for HF therapy, with the exception of drug therapy (examination, inpatient and outpatient treatment), averages RUB 108291 per year. The total direct nonmedical and indirect costs per HF patient per year were about RUB 44519 per year. It should be noted that the rehabilitation costs were not included in the calculation.Conclusion. Taking into account the significant burden of HF on the Russian healthcare system, the growing costs of healthcare and the increase in life expectancy, prevention and treatment of HF should be improved. The development of a HF centers’ network, creating a seamless system of HF care, as well as improving the availability of medication therapy and the inpatient management of patients can improve the healthcare quality for HF patients in Russia.

In this literature review, an attempt is made to analyze the interrelationships of the main sex hormones with the processes of development and progression of insulin resistance as a fundamental pathogenetic component of insulin-glucose homeostasis. In the evaluation of sex steroids, a complex approach was used - the associations of both androgens and estrogens in males and females are described in detail, a great deal of attention is paid to the violation of the secretion and effectiveness of the main adipocytokines - leptin and adiponectin in the sex hormone-insulin-glucose interaction chain. At the end of the review, new data on the expression of sodium-dependent glucose cotransporter (SGLT) and glucose transporters (GLUT) in animals, depending on sex, are presented.