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.

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В связи с улучшением диагностики и лечения болезней продолжительность жизни населения постепенно растет, однако при этом увеличивается число больных, имеющих несколько хронических заболеваний. Существуют различные термины, описывающие наличие нескольких заболеваний у одного больного. В англоязычной литературе это «коморбидность», «мультиморбидность», в русскоязычной-«сочетанная патология», «полипатия», «полиморбидность». Для всесторонней оценки состояния больного, страдающего несколькими заболеваниями, нужно учитывать их взаимное влияние, что лежит в основе клинического подхода в медицине-«лечить не болезнь, а больного». В связи с этим, на наш взгляд, можно согласиться с мнением ряда авторов, которые считают, что использование термина «мультиморбидность» в применении к конкретному больному более оправданно, поскольку в его основе, в отличие от понятия коморбидности, лежит не заболевание, а конкретный пациент со множеством хронических патологий, равнозначных между собой [1, 2]. Одним из наиболее распространенных заболеваний, встречающимся в общей популяции с частотой от 0,5 до 2%, является ревматоидный артрит (РА), характеризующийся стойкой потерей трудоспособности больных, повышением риска развития кардиоваску-О р и г и н а л ь н ы е и с с л е д о в а н и я ГБОУ ВПО «Саратовский государственный медицинский университет им.

Цель исследования-изучение частоты и структуры коморбидных состояний у двух групп больных ревматоидным артритом (РА) в разные годы наблюдения.

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period.

The purpose of this study was to investigate autonomous regulation of the cardiac activity by means of the heart rate variability (HRV) assessment and possible influence of conventional cardiovascular risk factors and disease activity parameters on it in patients with psoriatic arthritis (PsA). In total, 38 patients with the reliable diagnosis of PsA without clinically manifest cardiovascular pathology, known rhythm or conduction disturbances, diabetes mellitus, and hypercholesterolemia were included. In the control group, 25 age- and sex-matched healthy persons comparable with PsA patients in cardiovascular risk profile were included. For the HRV analysis, we used 5-min-long ECG records obtained at rest. Time and frequency domain parameters of HRV were calculated. Patients with PsA had decreased HRV in comparison to healthy controls as reflected by decrease of the standard deviation of normal R-R intervals (65.1 ± 66.8 vs. 83.2 ± 43.3 ms, respectively, p = 0.011), of the percentage of normal R-R intervals that differ by more than 50 ms (12.9 ± 15.4 vs. 20.6 ± 17.1 %, respectively, p = 0.035), and of the total power (2,069.4 ± 1,537.8 vs. 2,942.5 ± 1,734.2 ms(2), respectively, p = 0.006). A significant correlation of HRV parameters with disease duration and parameters of disease activity in PsA was found. Patients with PsA had impaired autonomous regulation of the cardiac activity, which is likely to be related to the presence of systemic inflammation and which could contribute to the increase of cardiovascular risk in this disease.

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Aim. Study the impact of various combinations of comorbid original diseases in patients infected with COVID-19 later on the disease progression and outcomes of the new coronavirus infection. Materials and methods. The ACTIV registry was created on the Eurasian Association of Therapists initiative. 5,808 patients have been included in the registry: men and women with COVID-19 treated at hospital or at home. ClinicalTrials.gov ID NCT04492384. Results. Most patients with COVID-19 have original comorbid diseases (oCDs). Polymorbidity assessed by way of simple counting of oCDs is an independent factor in negative outcomes of COVID-19. Search for most frequent combinations of 2, 3 and 4 oCDs has revealed absolute domination of cardiovascular diseases (all possible variants). The most unfavorable combination of 2 oCDs includes atrial hypertension (AH) and chronic heart failure (CHF). The most unfavorable combination of 3 oCDs includes AH, coronary heart disease (CHD) and CHF; the worst combination of 4 oCDs includes AH, CHD, CHF and diabetes mellitus. Such combinations increased the risk of lethal outcomes 3.963, 4.082 and 4.215 times respectively. Conclusion. Polymorbidity determined by way of simple counting of diseases may be estimated as a factor in the lethal outcome risk in the acute phase of COVID-19 in real practice. Most frequent combinations of 2, 3 and 4 diseases in patients with COVID-19 primarily include cardiovascular diseases (AH, CHD and CHF), diabetes mellitus and obesity. Combinations of such diseases increase the COVID-19 lethal outcome risk.