Most cardiovascular diseases (CVD) are of atherosclerotic origin, and lipid disorders play significant role, setting up the cardiovascular continuum, together with other risk factors. It also known that decrease of low density lipoproteins cholesterol (CLDL) level leads to decreased occurrence of CVDs in primary and secondary prevention of the diseases. Statins, at the moment, are a standard of medical care. However, two problems remain on the way to cardiovascular risk reduction — insufficient statins prescription and low rate of archived target levels of cholesterol and CLDL. In the end of October 2017, by the initiative of Sandoz LLC, in Kazan an educational seminar was conducted, where the representatives from 12 regions discussed the issues on statin therapy adherence improvement. Seminar program included lectures, practical interactive events and general discussion. As a specifics of the seminar, the participants not only listened to lectures, but prepared proposals in interactive regimen, discussed them with the colleagues, presented and defended projects. So, every participant was merged into the problem and directly influenced the discussion. Among the participants were internists, cardiologists, neurologists. Seminar vector was directed to revealing and overcoming such barriers for statin adherence as the socalled barriers of consent, understanding and availability, that depend on clinician as well as patient and healthcare system. Also the issues were discussed on the Internet influence on “antistatin” behavior, that prefers “good” bioactive compounds for “vile” statins.
Background: Chronic obstructive pulmonary disease (COPD) may frequently be complicated by sleep disorders, which worse quality of life and lead to other adverse consequences. The objective of the study was to analyze clinical course of the disease and quality of life in elderly patients with both COPD and sleep disorders. Methods and Results:The study included 50 patients with moderate and severe COPD in age from 60 to 75 years (mean age, 66.12±0.76 years). Patients were divided into 2 groups randomly. For patients in Group 1, 3 mg of melatonin was prescribed orally 30-40 minutes before bedtime for 14 days on the background of standard COPD therapy. Patients of Group 2 received only standard COPD therapy. After 12 months of follow-up, the number of exacerbations and hospitalizations for COPD significantly decreased in Group 1: from 3.74±0.19 to 1.91±0.20 times a year (P=0.0000) and from 2.08±0.18 to 1.35±0.18 (P=0.0046). In Group 2, the dynamics of these parameters was not statistically significant. In addition, along with the improvement of sleep quality in COPD patients during treatment with melatonin, both state and trait anxiety scores and depression level improved. In Group 1, SF-36 scores (PF, RP, BP, and GH) have also significantly improved.Conclusion: Correction of sleep disorders by melatonin in elderly patients with COPD improved the effectiveness of COPD treatment, and reduced the frequency and duration of exacerbations and the number of outpatient visits and hospitalizations.
Goal. The pilot project to organize or conduct performance improvement of existing structural units in specific hospitals (LU) Russia to provide rehabilitative care for patients with cardiovascular diseases in three stages under the current "Procedure for the provision of medical care for patients in medical rehabilitation", to introduce in practice these units tested scientifically sound approaches, forms and methods of cardio-rehabilitation, and try to create some patients routing algorithm. Material and methods. The pilot project includes 17 of the medical institutions of 13 regions of Russian Federation. Single special cards that allow to evaluate the appropriate order on the medical rehabilitation provided rehabilitation assistance to cardiac patients, a multidisciplinary team involved in the provision of rehabilitation assistance, staffing and equipping MI To analyze the effectiveness of organizational models in cardiorehabilitation MI have been developed. Special cards consisted of three sections, each of which allows you to evaluate the effectiveness of each of the three stages cardiorehabilitation: Stage I - unit intensive care unit (BRIT), and a specialized cardiology department; Stage II - stationary cardiorehabilitation department; Stage III - patient department cardiorehabilitation. The article presents the results of a three-year analysis from January 2013 to December 2015. Results. The pilot project was organized with the cardiorehabilitational help stage I in 10 DR, II stage - a 10-LU and Phase III - 7 DR. By 2015, almost all of Latvia to provide assistance in cardiorehabilitational area, multidisciplinary teams consisting of a cardiologist, cardiologist, rehabilitator, medical physical culture (physical therapy) specialist, physical therapy instructor-methodologist, psychotherapist, clinical psychologist, physiotherapist were formed. They were provided and equipped with facilities to practice physical therapy, room for educational schools. Home rehabilitation process BRIT has reduced the patient's stay in the bed of 0.7 days (2013 to 2015) and for 1 day in the cardiology department. On average, 67% of patients with acute myocardial infarction (AMI) were translated into Phase II cardiorehabilitaяtion in which they have become actively involved in the physical rehabilitation program, which is based on a classic exercise therapy, dosage walking in the room, physical training on simulators. Each MI educational schools were organized for patients actively pursued discussions with the relatives. Special complexity of the project has caused the organization phase III cardiorehabilitation. The project is currently ongoing. Conclusion. The analysis of the organization of a three-stage kardioreabilitatsionnoy care system with AMI patients considering the use of staffing, equipment and methodology, according to the current normative law, showed a significant increase in recreational activities created by multidisciplinary teams in all three stages of cardio-rehabilitation, increasing the number of used rehabilitation methods and improve the quality of their performance, as well as demonstrated safety of the proposed principles of physical rehabilitation, according to Russian clinical guidelines "Acute myocardial infarction with ST-segment elevation ECG: rehabilitation and secondary prevention", in the framework of the proposed organizational models cardiorehabilitation.
Актуальность У больных с многососудистым поражение коронарных артерий и ствола левой коронарной артерии коронарное шунтирование (КШ) является эффективным методом лечения. В тоже время у ряда пациентов в различные сроки после успешно проведенной хирургической реваскуляризации миокарда развивается клинически выраженная хроническая сердечная недостаточность (ХСН).Материалы и методы Обследовано 32 пациента с ишемической болезнью сердца и ХСН III/IV функционального класса (ФК) по NYHA, манифестирующей через 8±2 года после КШ. Фракция выброса левого желудочка после хирургической реваскуляризации миокарда при манифестации ХСН составила 34,1± 4%. 25 (78%) пациентам, включенным в исследование были выполнены коронаро-, шунтография. После рассмотрения кардиологическим консилиумом результатов обследования данным больным повторная реваскуляризация миокарда была не показана. В связи с сохраняющейся низкой переносимостью физических нагрузок пациентам дополнительно к базовой терапии ХСН был назначен экзогенный фосфокреатин (Неотон) внутривенно капельно в суточной дозе 3±0,5 гр. на 12±2 дня. Доза экзогенного фосфокреатина выбиралась в зависимости от степени ФК сердечной недостаточности. Результаты и их обсуждение Добавление фосфокреатина к стандартной терапии привело к улучшению ФК ХСН у 17 из 32 (53%) пациентов, включенных в исследование. У 30% больных, ответивших на терапию фосфокреатином (Неотон), повышение переносимости физической нагрузке наблюдалось после 1 курса терапии, у 70% пациентов - после 2 курса лечения препаратом. На фоне лечения фосфокреатином (Неотон) в целом по группе отмечалось достоверное повышение ФК ХСН с 3,4± 0,3 до 2,7± 0,6 (р <0,001). Наибольшая эффективность препарата была отмечена у пациентов с III ФК ХСН. Побочные эффекты терапии наблюдались у 3 (9%) пациентов и проявлялись в виде развитие умеренной гипотонии в основном при введении более 4 гр. препарата, которая купировалась снижение скорости инфузии фосфокреатина (Неотон).Вывод Лечение экзогенным фософокреатином (Неотон) больных с III/IV ФК ХСН после проведенного КШ позволяет более чем у 50% пациентов уменьшить клинические проявления сердечной недостаточности и повысить толерантность к физическим нагрузкам при хорошей переносимости терапии. Рекомендуется включение данного препарата в комплексное лечение ХСН у больных ишемической болезнью сердца (ИБС) при невозможности повторной реваскуляризации миокар
Aim Improvement of quality of life is one of the most important goals for the treatment of patients with chronic heart failure (CHF). This study searched for ways to increase the efficiency of CHF treatment based on parameters of quality of life in CHF patients during and after the treatment with exogenous phosphocreatine (EP).Material and methods The effect of a single course of EP treatment on quality of life of patients with functional class (FC) II-IV CHF with reduced or mid-range left ventricular ejection fraction was studied as a part of the all-Russia prospective observational study BYHEART. The presence of FC II-IV CHF and a left ventricular ejection fraction <50 % were confirmed by results of 6-min walk test (6MWT) and findings of echocardiography after stabilization of the background therapy.Results An interim data analysis showed that the course of EP treatment was associated with a significant improvement of quality-of-life indexes as determined by the Minnesota Living with Heart Failure Questionnaire (LHFQ) total score. These indexes significantly increased and remained at a satisfactory level for 6 mos. following completion of the treatment course. Also, the treatment significantly beneficially influenced the clinical condition of patients (heart failure severity scale), results of 6MWT, and the increase in left ventricular ejection fraction.Conclusion The conclusions based on results of the interim analysis should be confirmed by results of the completed study. Complete results are planned to be published in 2022.
The study involved 24 patients with coronary heart disease (CHD) and chronic heart failure II-IV FC according to NYHA, also the systolic dysfunction of the left ventricle and sinus tachycardia needing surgical myocardial revascularization in EC conditions (extracorporeal circulation). All patients had II-IV functional class (FC) of CHF (chronic heart failure) according to NYHA (average 2,8±0,6). FC of effort angina was 2,6±0,4 (CCS). 92% of patients had a history of myocardial infarction and sinus rhythm. To correct CHF, coronary insufficiency and to prepare for CABG in EC conditions, the drug therapy by means of ACE-inhibitors of angiotensin-receptor blockers, beta- blockers, calcium channel blockers, diuretics, digoxin and aldosterone antagonists was carried out all patients. Average heart rate (HR) at rest was 98±6 per minute. To achieve further normal HR in the drug therapy was added the Ivabradine in the dose of 10-15 mg per day for 18-38 days prior to myocardial revascularization. The use of the Ivabradine in the dose of 13±1 mg per day allows to decrease FC of CHF and coronary insufficiency in the patients with low contractile ability of the myocardium and hemodynamically significant stenosis of coronary arteries and to achieve normal HR in 75 % of patients with good tolerability.
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