Background: Death rates from cardiovascular disease in Russia are among the highest in the world. In recent years, the Russian government has invested substantially in the healthcare system, with a particular focus on improving access to advanced technology, especially for acute myocardial infarction (AMI). This protocol describes a study to understand the management of AMI in different Russian regions, investigating the role of patient, clinical, and health system characteristics. Methods: A prospective observational study has recruited a representative sample of AMI patients within 16 hospitals from 13 regions across Russia. Criteria for inclusion are being aged 35-70 years with a confirmed diagnosis of AMI and surviving until the day after admission. Information being collected includes health system contacts and features of clinical management prior to the event and in the 12 months following discharge from hospital. Following initial exploration of the data to generate hypotheses, multivariate analyses will be applied to assess the role of these characteristics in both treatment decisions and any delays in time critical interventions. Between June 2015 and August 2016, 1,122 patients have been recruited at baseline and follow-up to 12 months post-discharge is scheduled to be completed by autumn 2017. The study is unique in examining patient factors, clinical management prior to admission and in hospital in the acute phase and throughout the critical first year of recovery across a diverse range of geographies and facilities. It uses standardized instruments to collect data from patients and health care providers and includes regions that are diverse in terms of geography and development of cardiology capacity. However, given the limited health services research capacity in the Russian Federation, it was not possible to obtain a sample that was truly nationally representative.
Aim. To describe the characteristics of the patient with MI who is admitted to a hospital and to characterize the main diagnostic and treatment interventions in clinic. Material and methods. This study is observational and the part of big international project. It includes a representative sample of patients with MI admitted to 16 clinics in 13 regions of Russian Federation (Arkhangelsk region, Belgorod region, Bryansk region, Tver region, Saratov region, Rostov region, Samara region, the Republic of Tatarstan, Perm region, Tyumen region, Khanty-Mansiysk Autonomous district, Kemerovo region, Altai region). Patients were selected at random from among those experiencing a MI that were alive on the next morning after hospitalization. Enrollment took place from June 2015 to August 2016. Results. Of 1,128 patients included in the study, 872 were male (77.3%) and 256 females. 21.4% of patients had a previous MI, 8.3% had undergone PCI, and 2.2% CABG. Turning to cardiovascular risk factors, 46.2% of patients smoked prior to hospitalization, 34.6% were obese and 52.1% had a high cholesterol level. Only 40.0% of patients had no contact with the health care system within 12 months before the MI. Every fourth patient (25.1%) had undergone dispensarisation within 12 months before MI, women significantly often than men (33.5% and 22.6%, p<0.001). Initial revascularization was performed in 73.2% of patients, PCI was the initial revascularization attempt in 49.4% of patients, and PCI with stenting in 46.7%. Conclusion. Patient with a MI in Russian clinics is likely to have had a history of cardiovascular disease, and to have regular contact with the health care system within 12 months before the development of cardiovascular event. We demonstrated the high rates of appropriate MI treatment, without significant gender and age difference (except for thrombolysis), however, there is a reserve for increasing the proportion of patients who are undergoing revascularization.
We report the case of the development of pulmonary embolism in a patient with Paget-Schroetter disease.
Aim. To assess the prevalence, severity and prognostic value of renal dysfunction (RD) in patients with pulmonary embolism (PE) of the Russian population, as well as to determine the RD significance as a marker that improves the predictive ability of current risk stratification systems.Material and methods. From April 2018 to April 2019, patients hospitalized due to PE were sequentially included in the Russian multicenter observational prospective registry SIRENA. RD was diagnosed at a glomerular filtration rate (GFR) <60 ml/ min/1,73 m2. Risk of early (hospital or 30-day) death was stratified in accordance with the current 2019 ESC Clinical Guidelines. During the study, we analyzed inpatient mortality and complication rate.Results. A total of 604 patients (men, 293 (49%); women, 311 (51%)) were in the study. RD was detected in 320 (53%) patients, while severe dysfunction — in 63 (10%) ones. In addition, 71 (12%) patients had high death risk, 364 (61%) — intermediate, 164 (27%) — low. During hospitalization, 107 (18%) patients died, including 32% from the high-risk group, 20% — moderate, and 7% — low. RD in the deceased patients was diagnosed more often, while GFR <50 ml/min/1,73 m2 reliably predicted hospital mortality (sensitivity, 67%; specificity, 72%; AUC=0,72; p<0,001). In patients with simplified Pulmonary Embolism Severity Index (sPESI) of 0 and ≥ 1, the presence of RD led to at least a 2-fold increase in mortality. Multivariate Cox regression revealed that RD is a predictor of in-hospital mortality (hazard ratio (HR), 3,41; 95% confidence interval (CI): 2,15-5,41; p<0,001), regardless of the presence of death risk reclassifies, such as high troponin (HR, 1,31; 95% CI: 0,80-2,14; p=0,28) and right ventricular dysfunction (HR, 1,23; 95% CI: 0,74-2,04; p=0,42).Conclusion. In patients with PE of the Russian population, there is a high incidence of RD, which is diagnosed in every second patient and is severe in 10% of cases. The presence of RD is associated with a significant increase in in-hospital mortality, while the risk of death increases with a decrease in GFR. The addition of RD, considered as a decrease in the estimated GFR <60 ml/min/1,73 m2, to the sPESI improves risk stratification and allows identification of patients at high risk of in-hospital death.
Introduction. The independent role of the atrial septal aneurysm in the occurrence of ischemic stroke remains controversial. In addition to the mechanism of paradoxical embolism against the background of a patent foramen ovale associated with an aneurysm, a number of studies have demonstrated that ischemic stroke can develop due to in situ thrombosis in the aneurysm region.Materials and methods. Description of the clinical case of a patient with atrial septal aneurysm and ischemic stroke while taking hormonal contraceptives. Analyzed all available publications in PubMed on this topic.Results and discussion. Among publications suitable for the criteria, in addition to direct visualization of a blood clot in the area of the atrial septal aneurysm, its independent effect on the occurrence of embolic events was demonstrated. In all analyzed cases, anticoagulants were prescribed for secondary prevention, which is justified on the basis of the hypothesis of in situ thrombosis in the aneurysm region.Conclusion. The analysis of scientific publications showed that the knowledge of this problem is still extremely small. There are no clear criteria, in addition to direct visualization of a blood clot, allowing the atrial septal aneurysm to be considered as a direct cause of ischemic stroke. Nevertheless, the presence of this cardiac abnormality and in combination with risk factors or evidence of prothrombotic status make it possible to regard it as an independent cause of stroke, and qualify the stroke as cardioembolic, which justifies the advisability of prescribing anticoagulants for secondary prevention.
Background: Death rates from cardiovascular disease in Russia are among the highest in the world. In recent years, the Russian government has invested substantially in the healthcare system, with a particular focus on improving access to advanced technology, especially for acute myocardial infarction (AMI). This protocol describes a study to understand the management of AMI in different Russian regions, investigating the role of patient, clinical, and health system characteristics. Methods: A prospective observational study has recruited a representative sample of AMI patients from 16 hospitals in 13 regions across Russia. Criteria for inclusion are being aged 35-70 years with a confirmed diagnosis of AMI and surviving until the day after admission. Information being collected includes health system contacts and features of clinical management prior to the event Discuss this article(0) Comments health system contacts and features of clinical management prior to the event and in the 12 months following discharge from hospital. Following initial exploration of the data to generate hypotheses, multilevel modelling will be applied to assess the role of these characteristics in both treatment decisions and any delays in time critical interventions. Between June 2015 and August 2016, 1,122 patients have been recruited at baseline and follow-up to 12 months post-discharge is scheduled to be completed by autumn 2017. The study is unique in examining patient factors, clinical management prior to admission and in hospital in the acute phase and throughout the critical first year of recovery across a diverse range of geographies and facilities. It uses standardized instruments to collect data from patients and health care providers and includes regions that are diverse in terms of geography and development of cardiology capacity. However, given the limited health services research capacity in the Russian Federation, it was not possible to obtain a sample that was truly nationally representative.
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