Clinical and Anamnestic Characteristics, Cardiovascular Pharmacotherapy and Long-term Outcomes in Multimorbid Patients after COVID-19

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Aim. To describe the experience of creating the Outpatient-Polyclinic Register of the Multi-specialty Medical Center (TERRA) and the first results of the study.Material and methods. The TERRA registry included 32264 patients (age 44,0±15,3 years; 32,2% men) who applied to the multidisciplinary medical center from January 1, 2018 to December 31, 2021. Information from electronic outpatient records was evaluated. The data of patients with/without cardiovascular diseases (CVDs) in those who applied to general practitioners, cardiologists and other specialists, those with and without coronavirus disease 2019 (COVID-19) were compared.Results. There were 26,8% of patients with CVDs, while with ≥2 CVD — 8,1%, with CVD and/or chronic non-cardiac disease — 54,1%, their combination — 26%. Among those who consulted cardiologists, general practitioners and doctors of other specialties, hypertension was most often recorded — 64,8; 34,9 and 18,6%, coronary artery disease — 15,1, 6,2 and 3,2%, while from chronic non-cardiac diseases — diseases of the digestive system (64,4; 58,0 and 33,7%), kidneys (29,8; 24,9 and 13,2%), respiratory organs (28,4; 23,8 and 12,6%). The proportion of COVID-19 survivors was 8.2%, in patients with and without CVD — 14,8 and 5,1%, respectively (p<0,001). The proportion of CVD cases among survivors and non-survivors of COVID-19 was 58,0% and 25,2%, respectively (p<0,001). In addition, 88% of patients with CVDs consulted a cardiologist or general practitioner, of which 42% were observed by them together.Conclusion. The majority of patients at the multidisciplinary medical center had CVDs and chronic non-cardiac diseases, and more than a quarter had a combination of both. Patients with CVDs were more likely to have chronic non-cardiac diseases (2,2 times) and a history of COVID-19 (2,9 times). Among patients with a history of COVID-19, there was a higher proportion of cases of CVDs (by 2,3 times) and chronic non-cardiac pathology (by 1,8 times). Almost half of patients with CVD were observed jointly by a cardiologist and a general practitioner.

Section: Discussionunclassified

Outpatient-Polyclinic Register of the Multidisciplinary Medical Center (TERRA): general characteristics and first results

Lukyanov¹,

Andreenkо²,

Smirnov³

et al. 2023

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“…При тяжелом течении COVID-19 показана госпитализация, причем пациенты с коронавирусной инфекцией при сочетании с сердечно-сосудистыми заболеваниями (ССЗ), по сравнению с таковы-ми без ССЗ, характеризуются большей частотой фатальных и нефатальных осложнений как на госпитальном этапе лечения, так и после выписки из стационара 1 [6][7][8][9]. Однако кардиоваскулярная фармакотерапия у данной категории пациентов при длительном наблюдении на последующем амбулаторном этапе изучена лишь в отдельных работах [10]. В первые месяцы пандемии COVID-19 диагностика данного заболевания на амбулаторном этапе была не столь четко налажена (но разработана в последующем), в связи с чем некоторые пациенты экстренно госпитализировалась при наличии лишь подозрения на коронавирусную инфекцию еще до подтверждения данного диагноза, но в связи с тяжелым состоянием, обусловленным сочетанием как неуточненной респираторной вирусной инфекции и/или пневмонии, так и выраженных клинических проявлений хронической патологии терапевтического профиля, включая ССЗ.…”

Section: Introductionunclassified

Medical treatment of patients with cardiovascular diseases during the first year after hospitalization for COVID-19

Kutishenko¹,

Lukyanov²,

Martsevich³

et al. 2023

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Aim. To evaluate the medical treatment of patients with cardiovascular disease (CVD) during the first year of follow-up after hospitalization for coronavirus disease 2019 (COVID-19) in a prospective registry.Material and methods. The material for the study was obtained from the database of the TARGET-VIP inhospital registry. The registry included 1130 people. Of 863 patients discharged from the hospital with a diagnosis of COVID-19, 473 (548%) patients with CVD were selected, and 31 (40,8%) patients were selected from 76 patients in whom the diagnosis of COVID-19 was not confirmed with CVD.Results. At the stage of discharge from the hospital, the quality of therapy for CVD was insufficient on average, the frequency of proper prescriptions was 59,5%. During the first year, there was a significant trend towards a decrease in the prevalence of antihypertensive therapy for hypertension (p=0,018), anticoagulants for atrial fibrillation (p<0,001) and an increase in prescribing angiotensinconverting enzyme inhibitors/angiotensin receptor blockers for heart failure (p=0,037). The average prevalence of prescribing proper cardiovascular pharmacotherapy after 30-60 days and 6 months of follow-up was significantly less than at discharge from the hospital. In both groups of patients, when comparing the average frequency of compliance with proper prescriptions at all follow-up periods, as well as when comparing these indicators between groups, no significant differences were found, with the exception of the stage of 30-60 days after discharge from the hospital (p=0,009).Conclusion. In the TARGET-VIP registry after discharge from the hospital, the prevalence of proper appointments for CVD was insufficient. During the first year of observation, patients with CVD showed a significant decrease in the frequency of proper prescription of antihypertensive therapy for hypertension and anticoagulants for atrial fibrillation. When comparing groups of patients with confirmed and non-confirmed COVID-19, a higher average rate of adherence to proper prescriptions was found in patients with confirmed COVID-19. However, significant differences were found only 30-60 days after discharge.

Short- and long-term outcomes of patients with COVID-19 and acute kidney injury

Khruleva

Efremovtseva

Timofeeva

et al. 2023

Aim. To evaluate the impact of acute kidney injury (AKI) on in-hospital (death) and long-term outcomes (rehospitalization or death within 30 days; death within 180 days) in hospitalized patients with coronavirus disease 2019 (COVID-19).Material and methods. The registry of patients with COVID-19 was analyzed to identify risk factors (RFs) for mortality. Discharged patients were included in a prospective study. Outcomes were assessed by telephone contacts.Results. The study included 1000 patients. The mortality rate was 20,8%, while AKI was registered in 29,6% of patients. According to multivariate analysis, AKI, regardless of other risk factors, increased the risk of death (hazard ratio (HR), 1,62, 95% confidence interval (CI): 1,08-2,44, p=0,02). The prospective part included 691 patients. We revealed that 10% were rehospitalized or died within 30 days, while independent risk factors were age >65 years (HR, 2,72, 95% CI: 1,47-5,01, p=0,001) and AKI in the acute phase of COVID-19 (HR, 1,67, 95% CI: 1,00-2,80, p=0,05). In addition, 6% of patients died within 180 days, while AKI was the risk factor for death according to univariate analysis; the only independent predictor was age >65 years (HR, 5,96, 95% CI: 2,26-15,72, p<0,001).Conclusion. AKI during the acute period of COVID-19, independently of other risk factors, more than 1,5 times increases the risk of mortality and the risk of adverse outcome within 30 days after discharge.