Aim. To analyze prevalence of heart failure (HF), clinical and demographic characteristics, health care utilization, and outcomes according to the used International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes in regional integrated electronic health record database in Saint Petersburg.

Material and methods. The retrospective analysis of the Saint Petersburg regional integrated electronic health record database for 2019 was performed. At least one of the following ICD-10 codes has been considered as HF case: I50.x (standard coding) and/or I11.0, I13.0, I13.2, I25.5, I42.0, I42.9, I09.9, I43.0, I43.1, I43.2, I43.8, I42.5, I42.6, I42.7, I42.8 (extended coding).

Results. A total of 64070 adult patients with HF had medical encounters in 2019, 34,5% of whom were identified using standard coding, 65,5% — using extended coding. The combination of codes was observed in 9,9% of cases. HF prevalence/mortality was 1,4%/6,8% in general, as well as 0,49%/15,7% and 0,93%/2,1% with standard and extended coding, respectively. HF patients had high healthcare utilization with the mean number of 14 encounters per patient per year. Actually, 24% of patients had more than 20 both inpatient and outpatient encounters and 54% of patients — at least 1 all-cause hospitalization during the year. Encounters of patients with HF accounted for 4,3% of all visits, 6,5% of all hospitalizations, 4,1% of all outpatient visits and 9,7% of all emergency contacts during the year. Patients identified by the standard coding compared with the extended coding had older age and higher incidence of comorbidities, as well as greater hospitalization and death rates, but lower number of outpatient visits.

Conclusion. The prevalence of HF among the adult population of Saint. Petersburg in 2019 was 1,4%. HF was characterized by a high health care utilization and mortality rate reaching 15,7 % per year. The use of different approaches to coding presumably could help to identify different groups of patients with HF, which requires the adaptation of healthcare models and an active monitoring system to reduce the risk of adverse events.

Aim. To assess the retained knowledge of sixth year medical students on noninvasive blood pressure (BP) measurement.

Material and methods. The study included 148 6th year medical students. According to the curriculum, in the fall semester, students studied the procedure of BP measurement according to checklists developed based on ROSOMED. In the spring semester, as part of the preparation course for accreditation, the retained knowledge of students was assessed. A completed skill was assessed at 1 point, not completed — 0 points. Thus, each student can score a maximum of 50 points. The teacher assessed the manipulations during their performing by filling in the checklist items for each student.

Results. None of the students completed the full range of manipulations. The number of completed skills ranged from 15 (30%) to 49 (98%) and averaged 33 points on the checklist (66%). In addition, 74% of students (n=109) completed more than half of the required skills. Almost the only item completed by all students (99%, n=146) was a greeting, which was comparable with self-presentation (92%, n=136) and identification of a patient’s personal data (surname and first names) (80%, n=118). The rest of checklist items was performed in the range from 39% (n=57) for “remeasurement of BP on the other hand” to 87% (n=129) for “finding a radial pulse”. Thus, the average fulfillment rate was 67% (n=99). There were following most common mistakes in BP measurement: 39% of students did not measure a patient’s upper arm diameter and did not select the cuff size; every second student (51%) placed the phonendoscope diaphragm under the cuff; 40% of students reduced the cuff pressure with inadequate rate.

Conclusion. The retention of knowledge on measuring BP within six months after a detailed analysis and passing a test remains insufficient, but comparable with foreign studies. The data obtained indicate the need for additional trainings both using simulators and in conditions closer to real ones, including with simulated patients.

The success of myocardial infarction (MI) treatment largely depends on the timely delivery of quality health care, primarily on the blood flow restoration through the infarct-related artery. This review presents the results of several meta-analyzes and studies, including our own data, which indicate that delayed revascularization (>12 h from the onset) performed in patients with ST-segment elevation MI leads to an increase in the short- and long-term survival, a decrease in the incidence of cardiovascular events and severity of myocardial remodeling. For example, the analysis from the V. P. Polyakov Samara Regional Clinical Cardiological Dispensary showed the higher mortality rate in patients with ST-segment elevation MI admitted >12 hours from the onset, who received conservative treatment (7,9%) than in those with the invasive management (0,5%) (hazard ratio, 14,8; 95% confidence interval, 1,7- 124,7; P<0,05). However, at present, there is no complete clarity regarding the strategy of managing such patients. According to the current European Society of Cardiology guidelines on myocardial revascularization (2018), the class of recommendations reaches IIA, which means the conflicting data and/ or disagreement about usefulness/efficacy of a particular treatment method, but weight of evidence/opinion is in favor of usefulness/efficacy.

Heart failure (HF) is associated with unfavorable outcomes and high health care costs. Determination of the hemodynamic response to orthostasis can be an additional tool in assessing the stability and compensation of HF patients. Active orthostatic test (AOT) with blood pressure monitoring serves as a simple and available screening method. However, a complete characteristic of the hemodynamic response, especially during the first minute of orthostasis, can be obtained only with continuous blood pressure monitoring. The presented case series demonstrate the types of hemodynamic response in patients with heart failure with reduced ejection fraction in AOT with continuous blood pressure monitoring, available data on the mechanisms of its development, clinical and prognostic role, and also presents the advantages and limitations of AOT.

The article presents a case report of developing the classic hypertrophic obstructive cardiomyopathy in a 66-year-old male heart transplant recipient within 5 years after orthotopic heart transplantation. The characteristics of this pathology are discussed.

Introduction. Cardiovascular events at a young age are often the first manifestation of a genetic disorder such as familial hypercholesterolemia. High cholesterol levels, xanthomas and xanthelasmas, as well as a positive family history of cardiovascular disease, make it possible to identify a group of patients subject to genetic research. The identification of a specific mutation helps to determine further strategy not only for a patient, but also to his or her immediate relatives, thereby effectively conducting both secondary and primary prevention of atherosclerosis complications.

Brief description. Using the example of patients from the Krasnodar Lipid Center, the relevance of genetic testing and cascade screening is demonstrated. We show problems of delayed diagnosis and low medical adherence, as well as the ways to optimize care for patients with genetic lipid metabolism disorders.

Discussion. The rise in the incidence of cardiovascular events at a young age in developed countries prompts the search for more improved screening and diagnostic methods for familial hypercholesterolemia. The optimal age of initiation of lipid-lowering therapy in children with established familial hypercholesterolemia is also discussed. While secondary prevention appears to be clearer, there is still insufficient achievement of low-density lipoprotein cholesterol targets in patients with a previous cardiovascular event.

Due to the population aging and the accumulation of concomitant diseases, the prevalence of atrial fibrillation (AF) as the most common arrhythmia is increasing. On the other hand, 14% of the population has chronic kidney disease (CKD). These conditions are often combined with each other causing a prothrombogenic effect, which significantly increase the number of unfavorable outcomes such as thromboembolism, stroke, myocardial infarction and cardiovascular death. This is especially true for the last stages of CKD, the so-called end-stage renal disease with a glomerular filtration rate <29 ml/min/1,73 m². Previously, the vitamin K antagonist warfarin was the central drug for anticoagulant therapy of AF + CKD combination, but in the last decade, direct oral anticoagulants became widely used. This article discusses the evidence base for using each of the anticoagulants in patients with AF+CKD combination compared with warfarin, including depending on the severity of glomerular filtration rate decrease.

Public health strategies for the detection, prevention and treatment of cardiovascular diseases (CVDs) can be implemented at many levels as follows: from individual behavioral alterations to population-based strategies that affect different national and cultural communities. Despite the fact that the priority of primary prevention is treating hypertension and hyperlipidemia, great importance is given to improving behavioral and biological risk factors. Dietary modification, exercise and smoking cessation are specific interventions that can be targeted to reduce CVD risk at both the individual and population levels. Following a healthy lifestyle can potentially change factors such as overweight/obesity, hyperlipidemia, type 2 diabetes, and hypertension. The aim of this review was to present and summarize new data on the primary cardiovascular prevention with a focus on improving behavioral risk factors considered in the current guidelines.

The current literature review covers the role of sympathetic nervous system activation (SNS) and the significance of a new biomarker catestatin (CST), which is a chromogranin A-derived peptide, for assessing prognosis of patients with heart failure (HF). This review details the works devoted to CST metabolism and its role in clinical conditions with excessive catecholamine production, including the ability to counterbalance the adverse effects of SNS on cardiovascular system. The paper also presents the central results of studies on HF patients and shows the correlation of the CST level with HF functional class and stage. In addition, particular attention is paid on the possibilities and potential benefits of assessing the CST in addition to conventional management of patients hospitalized due to acute decompensated heart failure.

Chronic heart failure (CHF) is a pathology that affects more than 37 million people worldwide. Despite the introduction of new drugs into practice, that have proven their effectiveness in the treatment of patients with CHF, the life expectancy of these patients is growing at a slow pace. At the same time, the insufficient effect of neurohormonal blockers for the treatment of patients with CHF with preserved ejection fraction (CHFpEF), which prevails in the general structure of CHF, indicates a significant role of unidentified pathological processes in the development of this form of the disease. In recent years, the role of cardiac fibrosis has been actively studied within the framework of the investigation of the pathogenesis of CHFpEF, the probable biomarkers of which are interleukin (IL) 33 and suppression of tumorigenicity 2 (ST2). This literature review examines the influence of the IL-33/ ST2 interaction as a biomarker of cardiac fibrosis on the course of CHF and the possibilities of its practical application.

The introduction of evidence-based medicine into practical healthcare provides physicians with the opportunity to use treatment approaches, which have been proven to be effective in randomized controlled trials. In this case, it is necessary to consider using the medication in a particular patient in accordance with the design of clinical trials and strictly follow the instructions. Drugs should be critically selected with focus on quality of available efficacy and safety data obtained in the population closest to a patient. In addition, clinicians should regularly review the available data with particular regard to its quality. The advantages, disadvantages, limitations and methodological problems of observational studies should be carefully considered during the interpretation of results. At the same time, the compliance of the results of real-world evidence studies with registration trial data indicates a high reproducibility of medication effects.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe and underdiagnosed disorder that leads to right ventricular failure and, subsequently, to death. The article discusses the fundamental concepts of monitoring patients after a pulmonary embolism (PE) in order to timely detect CTEPH. The pathogenetic processes, risk factors and diagnostic criteria of this complication are described. The role of early diagnosis of CTEPH, which may be important in relation to further outcomes, is emphasized. A modern strategy for monitoring patients after PE is presented in detail, where echocardiography plays a key role. The stepwise diagnostic algorithm for CTEPH includes a comprehensive analysis of the patient’s condition: assessment of clinical status, identification of N-terminal pro-brain natriuretic peptide levels, cardiopulmonary exercise testing, imaging diagnostic procedures (ventilation/perfusion lung scanning, pulmonary angiography) and, finally, right heart catheterization. The article provides an overview of modern treatment options. CTEPH is a unique type of pulmonary hypertension because it is potentially curable with surgery — pulmonary thromboendarterectomy. For patients with inoperable or persistent/ recurrent CTEPH, medication therapy is recommended. Currently, the only drug with a high class of evidence for this group of patients is riociguat. A positive effect on exercise tolerance, functional class, and hemodynamic parameters has been shown in the CHEST-1,2 studies. The favorable safety profile of the drug was also demonstrated in the long-term follow-up in routine clinical practice (EXPERT registry). The presence of various options in the management of patients and development of a multimodal therapy makes it possible to provide high-quality care to patients with CTEPH, and, namely, fast and accurate diagnosis plays a key role in timely treatment.

The extent of the problem of heart failure determines the priority of the intention of developing and implementing an optimal model of medical care for this group of patients. The article describes the key components of the heart failure medical care (continuity, patient routing, educational activities) and provides examples of documents, protocols, checklists that can be used in real clinical practice by specialists in medical organizations in the regions of the Russian Federation.