The article presents the first experience of analyzing the treatment quality of hospitalized patients with heart failure based on electronic health records (EHR). We analyzed EHR of patients hospitalized in three large hospitals in Kirov. The results of the analysis indicated insufficient detailed information in the EHR, which complicates analyzing the accuracy of diagnosis and therapy quality. In particular, attention is drawn to the disproportionate number of patients with heart failure with reduced and preserved ejection fractionю This, apparently, is due to the low prevalence of assessing brain natriuretic peptides and conducting Doppler echocardiography. A separate part of the analysis is devoted to assessing the therapy quality in patients with concomitant diabetes. Despite the study limitations, the presented results can be useful for improving the quality of EHR filling for performing further observational clinical trials.

The population of older and oldest-old individuals is increasing at a rapid pace, leading to a notable proportion of this age group requiring surgical procedures due to multimorbidity. It is known that, compared with young people, patients over 60 have a whole set of factors, such as decreased physiological functions, the presence of several concomitant diseases, polypharmacy, cognitive dysfunction and specific geriatric syndromes, which may lead to a higher risk of postoperative complications and prolonged recovery. Therefore, an integrated multidisciplinary approach on management is necessary for this group of patients, but the use of such an approach is currently rare. The purpose of this document is to review the literature, summarize current recommendations, and provide a set of expert recommendations to assist practicing geriatricians, surgeons, anesthetists, and allied health professionals.

At an international online expert meeting held on September 16, 2021, the results of the empagliflozin research program EMPA-REG Outcome, EMPEROR-Reduced and EMPEROR-Preserved were reviewed. We analyzed cardiovascular and renal outcomes during the treatment with empagliflozin in patients with chronic heart failure, regardless of the presence of type 2 diabetes mellitus. The positive results of the EMPEROR-Preserved study are updated and their significance for clinical practice is discussed. Several proposals have been adopted that will accelerate the introduction of empagliflozin therapy into practice in patients with heart failure and overcome clinical inertia.

Expert Council opinion describes emergency care in a sudden individually significant blood pressure (BP) increase without clinically overt target organ damage. In the new guidelines of the Russian Society of Cardiology, the term “hypertensive urgency” was abolished, and the management of a sudden BP increase was changed. At the same time, a sudden individually significant BP increase may be accompanied by symptoms that reduce patients’ quality of life and ability to work. According to experts, individually significant BP increase accompanied by symptoms requires outpatient treatment using oral rapid-onset drugs with an optimal duration of action, in particular captopril. It has a much evidence-based data on the BP increase use and sublingual administration, and also has a favorable safety profile, which allows prescribing to patients with comorbid diseases. The rationale for the use of angiotensin-converting enzyme inhibitor Capoten (captopril) as a drug for self-management of a sudden individually significant BP increase accompanied by symptoms in hypertension patients is describes.

We present a consensus on high dose cholecalciferol (Devilam 5000 IU and 50000IU) prescription in clinical settings. There was a expert committee meeting to reach a consensus on the recommendations for endorcrinologists, primary care physicians and primary care specialists to prevent and treat vitamin D deficiency in various groups of patients. The expert committee reached a consensus on prescribing prophylactic doses of vitamin D in daily, weekly and monthly regimes to prevent vitamin D deficiency without vitamin D measurements. A single dose of cholecalciferol 50 000 IU should be prescribed to patients with low traumatic fractures and/or requiring antiresorptive treatment for osteoporosis when vitamin D measurement is not available. Treatment doses (50 000 IU per week) of vitamin D should be reserved for patients with established vitamin D deficiency (< 30ng/ml). Considering the prevalence of vitamin D deficiency in Russia, the expert committee suggested that all people require prophylactic doses of vitamin D from November to April, whereas the elderly (65+) benefit from whole year vitamin D supplementation. There is a group of people with vitamin D metabolism abnormalities associated with hypercalcemia (genetic or granulomatosis disorders) who should avoid vitamin D. On the other hand, patients with obesity, malabsorption and osteomalacia require higher doses of vitamin D for longer periods of time. High-dose vitamin D formulation in matrix form (50,000 IU, 5,000 IU) is a high-dose vitamin D preparation within the framework of the registered instructions for the prevention (in intermittent dosing mostly) and treatment of vitamin D deficiency/insufficiency. Taking into account the rapid achievement of a therapeutic effect, good tolerability, safety of the drug and the convenience of intermittent administration to achieve greater patient compliance with the treatment, the expert committee has come to the conclusion that high-dose vitamin D formulation in matrix form should be recommended in different group of people to be given according to this consensus.

World experience in off-label medicines use is presented in the article. Data on the history of changes in tactics and approaches to solve the problem of medicines off-label use in the USA and some European countries, as well as in the European Union as a whole, are presented. The reasons, why doctors should use medicines off-label, are discussed. The expert opinion on the conditions ensuring the maximum safety in off-label medicines use is presented. In particular, the validity of obtaining patient informed consent is discussed. The article does not apply to the Russian regulation regarding “off-label” therapy but describes the foreign practice related to off-label medicines use. In addition, the results of some recently completed randomized clinical trials evaluating the effects of direct oral anticoagulants are presented in order to demonstrate the need to clarify the effectiveness and safety of medicines used in certain clinical situations. The results of such studies clarify the indications for the drug use, which are subsequently entered into the summary of product characteristics.