Aim. Based on the results of a sociological survey of patients, to assess quality and availability of health care for cardiovascular diseases (CVDs) in 2020-2021 in the Russian Federation.Material and methods. In August-September 2021, 5159 patients with CVDs from 76 Russian regions were interviewed. Questionnaire (Google form) assessed the change in health care provision over the past two years, the availability of medicine provision, the prevalence and reasons for discontinuation of treatment, as well as the difficulties faced by patients.Results. Improvement in health care provision were assessed by 47,6% of the surveyed patients with CVD, worsening — by 16,6%, and 23,7% did not noted any changes. Improvements regarded diagnosis promptness (29%) and timeliness of treatment (28,5%), availability of subsidized medicines (25%) and better patient routing (21%). However, 37% of respondents did not see any improvements in health care system, or found it difficult to answer. The acute problem of access to diagnostics was considered by 24%, inaccessibility of subsidized medicines — by 17%. In addition, 24% of respondents had difficulties in obtaining specialized cardiology care in the polyclinic and 18% had difficulty in obtaining high-quality medical rehabilitation for CVD.Conclusion. In order to increase public satisfaction with the quality of care, public awareness on health maintenance and patients’ rights to receive care should be improved. In addition, possible barriers to obtaining health care should be eliminated, while consultative and diagnostic assistance and subsidized drug provision should be facilitated for receiving.

Management of patients with secondary progressive multiple sclerosis (SPMS) remains one of the most challenging tasks of modern neurology. Patients with SPMS present with more severe neurological symptoms, increased hospitalization frequency, pronounced cognitive impairment in most of them, and a higher level of fatigue than patients with relapsing-remitting MS (RRMS). Another unfavorable course of MS is primary progressive MS (PPMS) when there is a steady increase in neurological disorders from the very beginning of the disease.Objective: to compare medical and social characteristics and changes in quality of life (QoL) indexes in patients with PPMS and SPMS.Patients and methods. In total, 437 patients with PPMS from 19 constituent entities of the Russian Federation and 500 patients with SPMS from 15 Russian Federation regions were interviewed using the original medical and social questionnaire. At the same time, we studied the QoL of patients with PPMS and SPMS using the specific MusiQoL questionnaire.Results and discussion. Among the patients with PPMS, 54.3% were women and 45.7% – men. In patients with SPMS, women predominated (66.3% of women and 33.7% of men – the ratio was almost 2: 1). The degree of disability and the severity of the disease were higher in SPMS than in PPMS. The family continues to be the primary aid source in everyday life for patients with MS: 75–80% of patients who need such support receive it from their significant others. More patients with SPMS indicated a deterioration in their health status over the last year (70%, while among patients with PPMS – 55%). More patients with PPMS received outpatient care (82.1% compared to 64.7% in SPMS; p=0.01). Immobility and SPMS treatment problems were the main reasons for decreased outpatient care in patients with SPMS. Less than half of patients with SPMS (43.8%) and 62% of patients with PPMS received inpatient treatment. According to neurologists reports, there is a major problem in providing MS centers with effective drugs to treat both disease courses. When QoL was assessed, we found more profound changes in SPMS concerning both QoL's psychological and physical components. Only recently, a new drug, siponimod, has been approved for the treatment of SPMS. The lack of effective treatment formed the basis of negative attitudes towards the health care system in SPMS.Conclusion. QoL changes reflect the patient's attitude to his condition. The introduction of new drugs for the pathogenetic treatment of SPMS (siponimod) will improve the QoL indicators in SPMS.

Currently, it is possible to treat secondary progressive multiple sclerosis (SPMS). This is the most unfavorable type of multiple sclerosis (MS) and the article provides a medical and social analysis of MS course at this group of patients. There is evidence that these patients are highly socialized members of society, usually family members, so their non-participation in socially useful work significantly affects the whole life of society. Many of them receive pathogenetic treatment drugs that do not work at this stage of MS. That is, the large cost of purchasing medicines not only does not help these patients, but also is an irrational expenditure of public funds.