The period following heart failure hospitalization (HFH) is a vulnerable time with high rates of death or recurrent HFH.OBJECTIVE To evaluate clinical characteristics, outcomes, and treatment response to vericiguat according to prespecified index event subgroups and time from index HFH in the Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction (VICTORIA) trial. DESIGN, SETTING, AND PARTICIPANTSAnalysis of an international, randomized, placebo-controlled trial. All VICTORIA patients had recent (<6 months) worsening HF (ejection fraction <45%). Index event subgroups were less than 3 months after HFH (n = 3378), 3 to 6 months after HFH (n = 871), and those requiring outpatient intravenous diuretic therapy only for worsening HF (without HFH) in the previous 3 months (n = 801). Data were analyzed between May 2, 2020, and May 9, 2020.INTERVENTION Vericiguat titrated to 10 mg daily vs placebo. MAIN OUTCOMES AND MEASURESThe primary outcome was time to a composite of HFH or cardiovascular death; secondary outcomes were time to HFH, cardiovascular death, a composite of all-cause mortality or HFH, all-cause death, and total HFH. RESULTS Among 5050 patients in the VICTORIA trial, mean age was 67 years, 24% were women, 64% were White, 22% were Asian, and 5% were Black. Baseline characteristics were balanced between treatment arms within each subgroup. Over a median follow-up of 10.8 months, the primary event rates were 40.9, 29.6, and 23.4 events per 100 patient-years in the HFH at less than 3 months, HFH 3 to 6 months, and outpatient worsening subgroups, respectively. Compared with the outpatient worsening subgroup, the multivariable-adjusted relative risk of the primary outcome was higher in HFH less than 3 months (adjusted hazard ratio, 1.48; 95% CI, 1.27-1.73), with a time-dependent gradient of risk demonstrating that patients closest to their index HFH had the highest risk. Vericiguat was associated with reduced risk of the primary outcome overall and in all subgroups, without evidence of treatment heterogeneity. Similar results were evident for all-cause death and HFH. Addtionally, a continuous association between time from HFH and vericiguat treatment showed a trend toward greater benefit with longer duration since HFH. Safety events (symptomatic hypotension and syncope) were infrequent in all subgroups, with no difference between treatment arms.CONCLUSIONS AND RELEVANCE Among patients with worsening chronic HF, those in closest proximity to their index HFH had the highest risk of cardiovascular death or HFH, irrespective of age or clinical risk factors. The benefit of vericiguat did not differ significantly across the spectrum of risk in worsening HF.

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.

.

No abstract

65Введение В последние годы среди клиницистов приобретают все больший интерес и активно обсуждаются вопросы сочетанных заболеваний и коморбидных состояний.Известно, что сочетание патологических состояний вза-имно изменяет классическую клиническую картину бо-лезни, чаще всего утяжеляет течение заболеваний и увеличивает количество осложнений. Сочетание не-скольких заболеваний у одного пациента называют ко-морбидностью (полиморбидностью). Понятие «ко-морбидность» было предложено в 1970 г. A.R. Feinstein. Коморбидный пациент в гастроэнтерологии: индивидуальный подходИгорь Геннадьевич Бакулин, Сергей Анатольевич Сайганов, Мария Игоревна Скалинская*, Екатерина Васильевна Сказываева, Игорь Вадимович Лапинский Северо-Западный государственный медицинский университет им. И.И. Мечникова Россия, 191015, Санкт-Петербург, ул. Кирочная, 41 В связи с увеличением продолжительности жизни современного человека в последние годы среди клиницистов приобретают большой ин-терес вопросы коморбидных состояний. Коморбидность, нарастающая с возрастом пациентов, может снижать их приверженность к лечению, в том числе, и по причине использования многокомпонентных режимов терапии, что, в свою очередь, ведет к снижению эффективности про-водимого лечения. В связи с этим возникает необходимость индивидуального подбора терапевтических схем лечения с минимальными ле-карственными взаимодействиями. В статье на примере клинического случая представлен лечебно-диагностический алгоритм для коморбидного пациента при сочетании патологии пищеварительной и сердечно-сосудистой систем. Выбор лечебно-диагностического алгоритма основы-вался на современных российских и зарубежных рекомендациях. Акцент сделан на стратификации как гастроэнтерологических, так и кар-диологических факторов риска, и стратегии выбора ингибиторов протонной помпы в зависимости от клинической динамики. Дано обоснование замены ингибиторов протонной помпы с учетом вероятности межлекарственных взаимодействий у пациента с высокой степенью кардио-логического риска, принимающего ацетилсалициловую кислоту и имеющего высокий риск развития кровотечения из желудочно-кишечно-го тракта. Приведены данные нескольких крупных метаанализов, отражающих подходы по снижению риска развития гастропатий, ассоциированных с нестероидными противовоспалительными препаратами, при приеме дезагрегантов, а также проведения эрадикационной терапии у дан-ной группы больных.Ключевые слова: коморбидность, ингибиторы протонной помпы, нестероидные противовоспалительные препараты. In connection with the increase in the life expectancy of modern people, in recent years questions of comorbid conditions have become of great interest among clinicians. Comorbidity, which increases with the age of patients, may reduce their adherence to treatment, including because of the use of multicomponent regimens of therapy, which in turn leads to a decrease in the effectiveness of the treatment. In this regard, there is a need for individual adjustment of therapeutic regimens with minimal drug interactions. In the article, a clinical case i...