Cardiovascular risk management system: prerequisites for developing, organization principles, target groups

Cardiovascular morbidity and mortality are associated with high demographic and economic  losses.  Their decrease is one  of the  main lines of development  and improvement of the world health systems. An analysis of the current situation in the Russian  Federation  (RF) demonstrates that  the  areas  of concern  in system  for cardiovascular  diseases (CVD) patients’  care  are  the  insufficient and  untimely identification of cardiovascular risk factors, as well as their ineffective management due to the incomplete  implementation  of existing risk stratification guidelines and decision  making.  To achieve  the  aim of reducing  mortality from cardiovascular diseases by 2024 and further preserving of this tendency, along with the introduction of a  long-term  population-based strategy   for creating  a  healthy  lifestyle, it is necessary  to  shift  the  focus  from  emergency care  and  performing  high-tech interventions to long-term management of cardiovascular risks. The introduction of a new model of specialized care for cardiovascular diseases, the cardiovascular risk management system,  is aimed  at the  efficient use  of healthcare resources and providing the reduction in cardiovascular mortality.

1. Ralston J, Reddy KS, Fuster V, Narula J. Cardiovascular diseases on the global agenda: the United Nations high level meeting, Sustainable Development Goals, and the way forward. Glob Heart. 2016;11:375-9. doi:10.1016/j.gheart.2016.10.029.

2. WHO Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2020 (resolution WHA66.10, 27 May 2013), http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R10-en.pdf?ua=1 (19 Aug 2019).

3. Federal State Statistics Service (Федеральная служба государственной статистики), https://www.gks.ru/ (19 Aug 2019).

4. Russian Statistical Yearbook 2018, p. 694 (In Russ.) Российский статистический ежегодник 2018. Стат.сб./Росстат, 2018. 694 с.

5. Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. JACC 2017;70:1-25. doi:10.1016/j.jacc.2017.04.052.

6. Decree of the President of the Russian Federation of 07.05.2018 № 204 “On national goals and strategic objectives of the development of the Russian Federation for the period until 2024” Rossiyskaya Gazeta. №97с. 05/09/2018 (In Russ.)

7. “Passport of the national project “Healthcare” (in Russ.) http://www. consultant.ru (19 Aug 2019).

8. https://www.world-heart-federation.org/cvd-roadmaps (19 Aug 2019).

9. Riahi F, Dorling G, Callahan R, et al. Innovative Approaches to Prevention: Tackling the Global Burden of Cardiovascular Disease. Doha, Qatar: World Innovation Summit for Health, 2016, p.11.

10. Boytsov SA, Pogosova NV, Bubnova MG, et al. Cardiovascular prevention 2017. National guidelines. Russ J Cardiol. 2018;23(6):7-122. (In Russ.) doi:10.15829/1560-4071-2018-6-7-122.

11. Wall HK, Ritchey MD, Gillespie C, et al. Vital Signs: Prevalence of Key Cardiovascular Disease Risk Factors for Million Hearts 2022 — United States, 2011-2016. MMWR Morb Mortal Wkly Rep. 2018;67(35):983-91. doi:10.15585/mmwr.mm6735a4.

12. Wilkins E, Wilson L, Wickramasinghe K, et al. European Cardiovascular Disease Statistics 2017. European Heart Network, Brussels.

13. Tolpygina SN, Martsevich SY. Study of a trend in the frequency of using main drug classes indicated for the treatment of patients with chronic coronary heart disease in 2004 to 2014: data from the CHD prognosis registry. The Clinician. 2016;10(1):29-35. (In Russ.) doi:10.17650/1818-8338-2016-10-1-29-35.

14. Shalnova SA, Deev AD. High-risk patient characteristics. Results of the OSCAR Study: epidemiological part. Cardiovascular Therapy and Prevention. 2006;5(5):58-63. (In Russ.)

15. Ginzburg ML, Martsevich SY, Kutishenko NP, et al. The capabilities of a register as a quality control of the pharmacotherapy in outpatients at high risk of cardiovascular complications (The “LIS-1” Register). Ration Pharmacother Cardiol. 2014;10(3):288-92. (In Russ.)

16. Martsevich SY, Ginzburg ML, Kutishenko NP, et al. Changes in prehospital pharmacotherapy in patients with acute coronary syndrome in 2005-2014 according to the LIS register. Ration Pharmacother Cardiol. 2014;10(6):631-3. (In Russ.)

17. Boytsov SA, Martsevich SYu, Ginzburg ML, et al. Lyubertsy study on mortality rate in patients after cerebral stroke or transient ischemic attack (LIS-2). Design and medical treatment estimation. Ration Pharmacother Cardiol. 2013;9(2):114-22. (In Russ.)

18. Zubareva MYu, Rozhkova TA, Gornyakova NB, et al. Residual risk in patients treated with statins from the very high risk group of development atherogenic dyslipidemia. A prospective study “CRYSTAL” Part 1: Purpose, objectives, design, and baseline characteristics of the included patients. Ateroskleroz i dislipidemii. 2013;1:26-34. (In Russ.)

19. Oganov RG, Kukharchuk VV, Arutyunov GP, et al. (on behalf of the DYSIS Study Group) Persistent dyslipidemia in statin-treated patients: Russian real-world clinical practice data (Russian part of the DYSIS Study). Cardiovascular Therapy and Prevention. 2012;11(4):70-8. (In Russ.)

20. Boytsov SA, Luk’yanov MM, Yakushin SS, et al. Cardiovascular diseases registry (RECVAZA): diagnostics, concomitant cardiovascular pathology, comorbidities and treatment in the real outpatient-polyclinic practice. Cardiovascular Therapy and Prevention. 2014;13(6):44-50. (In Russ.) doi:10.15829/1728-8800-2014-6-44-50.

21. Ershova AI, Meshkov AN, Yakushin SS, et al. Diagnosis and treatment of patients with severe hypercholesterolemia in real outpatient practice (according to the RECVASA registry). Ration Pharmacother Cardiol. 2014;10(6):612-6. (In Russ.)

22. Akhmedzhanov NM, Nebieridze DV, Safaryan AS, et al. Analysis of hypercholesterolemia prevalence in the outpatient practice (according to the ARGO study): Part I. Ration Pharmacother Cardiol. 2015;11(3):253-60. (In Russ.)

23. Meshkov AN, Ershova АI, Deev АD, et al. on behalf of the ESSE-RF workgroup. Distribution of lipid profile values in economically active men and women in Russian Federation: results of the ESSE-RF study for the years 2012-2014. Cardiovascular Therapy and Prevention. 2017;16(4):62-7. (In Russ.)

24. Boytsov SA, Balanova YuA, Shalnova SA, et al. on behalf of the ECCD-RF workgroup. Arterial hypertension among individuals of 25-64 years old: prevalence, awareness, treatment and control. By the data from ECCD. Cardiovascular Therapy and Prevention. 2014;13(4):4-14. (In Russ.) doi:10.15829/1728-8800-2014-4-4-14.

25. Shalnova SA, Deev AD, Metelskaya VA, et al. on behalf of ESSE-RF trial workgroup. Awareness and treatment specifics of statin therapy in persons with various cardiovasular risk: the study ESSE-RF. Cardiovascular Therapy and Prevention. 2016;15(4):29-37. (In Russ.)

26. Levine DM, Linder JA, Landon BE. The Quality of Outpatient Care Delivered to Adults in the United States, 2002 to 2013. JAMA Intern Med. 2016;176(12):1778-90. doi:10.1001/jamainternmed.2016.6217.

27. Baranova EI, Soboleva AV, Aznauryan RS, et al. Adequacy of antithrombotic therapy for non-valvular atrial fibrillation in real clinical practice. Atherothrombosis. 2015;1:16-23. (In Russ.) doi:10.21518/2307-1109-2015-1-16-23.

28. Luk’yanov ММ, Martsevich SYu, Yakushin SS, et al. The Control of International Normalised Ratio in Patients with Atrial Fibrillation Treated with Warfarin in Outpatient and Hospital Settings: Data from RECVASA Registries. Rational Pharmacotherapy in Cardiology. 2018;14(1):40-6. (In Russ.) doi:10.20996/1819-6446-2018-14-1-40-46.

29. Fomin IV, Kraiem N, Polyakov DS, et al. The notion of CHF course stability: Is it acceptable for Russian practice? Kardiologiia. 2018;58(3S):55-63. (In Russ.) doi:10.18087/cardio.2356.

30. Catapano AL, Graham I, De Backer G, et al. ESC Scientific Document Group. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016;37(39):2999-3058. doi:10.1093/eurheartj/ehw272.

31. Order of the Ministry of Health of the Russian Federation of March 13, 2019 №124n “On approval of the procedure for conducting preventive medical examinations and medical examination of certain groups of the adult population”. Rossiyskaya Gazeta. № 7852. 04/29/2019. (In Russ.)

32. Order of the Ministry of Health of the Russian Federation dated March 29, 2019 № 173n “On approval of the procedure for conducting dispensary monitoring for adults” Rossiyskaya Gazeta. № 7852. 04/29/2019. (In Russ.)

33. Order of the Ministry of Health of Russia №918n dated November 15, 2012 “On the approval of the procedure for providing medical care to patients with cardiovascular diseases”. Rossiyskaya Gazeta. №90/1. 04/25/2013 (special issue). (In Russ.)

34. Federal Law of November 21, 2011 №323-FZ “On the Basics of Protecting the Health of Citizens in the Russian Federation”. Russian Newspaper. № 263. 11/23/2011. (In Russ.)

35. Order of the Ministry of Health of the Russian Federation dated November 30, 2017 No. 965n “On approval of the organization and provision of medical care using telemedicine technologies” Rossiyskaya Gazeta. №7466. 11.01.2018. (In Russ.)

36. Decree of the Government of the Russian Federation of 05.05.2018 №555 “On the unified state information system in the field of healthcare” Official gazette 14.05.2018. №20. art. 2849. (In Russ.)

37. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388:1459-544. doi:10.1016/S0140-6736(16)31012-1.

38. GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1345-422. doi:10.1016/S0140-6736(17)32366-8.

39. Forouzanfar MH, Liu P, Roth GA, et al. Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990–2015. JAMA 2017;317:165-82. doi:10.1001/jama.2016.19043.

40. Chazova IE, Oshepkova EV, Zhernakova YuV, et al. Diagnostics and treatment of arterial hypertension (Clinical Guidelines) Kardiologicheskij Vestnik. 2015;1(10):3-20. (In Russ.)

41. Carey RM, Calhoun DA, Bakris GL, et al. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension. 2018 Nov;72(5):e53-e90. doi:10.1161/HYP.0000000000000084.

42. Sim JJ, Bhandari SK, Shi J, et al. Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension. Kidney Int. 2015;88:622-32. doi:10.1038/ki.2015.142.

43. Tsioufis C, Kasiakogias A, Kordalis A, et al. Dynamic resistant hypertension patterns as predictors of cardiovascular morbidity: a 4-year prospective study. J Hypertens. 2014;32(2):415-22. doi:10.1097/HJH.0000000000000023.

44. Pierdomenico SD, Lapenna D, Bucci A, et al. Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens. 2005;18:1422-8. doi:10.1016/j.amjhyper.2005.05.014

45. Nordestgaard BG, Chapman MJ, Humphries SE, et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society. Eur Heart J. 2013;34(45):3478-90a. doi:10.1093/eurheartj/eht273.

46. Akioyamen LE, Genest J, Shan SD, et al. Estimating the prevalence of heterozygous familial hypercholesterolaemia: a systematic review and meta-analysis. BMJ Open 2017;7:e016461.

47. Yezhov MV, Bliznyuk SA, Tmoyan NA, et al. Register of patients with familial hypercholesterolemia and patients of very high cardiovascular risk with lipid-lowering therapy underperformance (RENESSANS). Russian Journal of Cardiology. 2019;24(5):7-13. (In Russ.)

48. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-962. doi:10.1093/eurheartj/ehw210.

49. Steger C, Pratter A, Martinek-Bregel M, et al. Stroke patients with atrial fibrillation have a worse prognosis than patients without: data from the Austrian Stroke registry. Eur Heart J. 2004;25(19):1734-40.

50. Mareev VYu, Fomin IV, Ageev FT, et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(6S):8-158. (In Russ.) doi:10.18087/cardio.2475.

51. Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Card Fail Rev. 2017;3(1):7-11. doi:10.15420/cfr.2016:25:2.

52. Uhlig K, Patel K, Ip S, et al. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Ann Intern Med. 2013;159(3):185-94. doi:10.7326/0003-4819-159-3-201308060-00008.

53. Omboni S, Gazzola T, Carabelli G, Parati G. Clinical usefulness and cost effectiveness of home blood pressure telemonitoring: meta-analysis of randomized controlled studies. J Hypertens. 2013;31(3):455-67. doi:10.1097/HJH.0b013e32835ca8dd.

54. McManus RJ, Mant J, Franssen M, et al. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial. Lancet. 2018;391(10124):949-59. doi:10.1016/S0140-6736(18)30309-X.

55. Fomin IV, Vinogradova NG, Farzaliev MI-ogly, et al. Efficiency of observing patients in the setting of a specialized center for treatment of chronic heart failure. Emergency cardiology and cardiovascular risks. 2018;2(1):221-9. (In Russ.)

56. Vinogradova NG. City Center for the Treatment of Chronic Heart Failure: the organization of work and the effectiveness of treatment of patients with chronic heart failure. Kardiologiia. 2019;59(2S):31-9. (In Russ.) doi:10.18087/cardio.2621.

57. Clark CE, Smith LFP, Taylor RS, Campbell JL. Nurse led interventions to improve control of blood pressure in people with hypertension: Systematic review and meta-analysis. BMJ 2010;341:c3995. doi:10.1136/bmj.c3995.

58. Santschi V, Chiolero A, Colosimo AL, et al. Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials. J Am Heart Assoc. 2014;3(2):e000718. doi:10.1161/JAHA.113.000718.