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Highlights. Ineffective clinical management of primary health care in the form of staffing shortage and low competence within the model of cardiovascular surgeons further contribute to the progression and complication of cardiovascular diseases. Primary health care specialist for cardiovascular diseases acts as a functional basis for clinical and organizational management of the processes of primary and secondary prevention of cardiovascular complications, the development of patients' adherence to recommendations and the formation of a healthy lifestyle. Improving professional skills and competencies of cardiovascular surgeons providing comprehensive medical care – surgical and conservative (the functional medicine model) remains an urgent healthcare issue.Aim. To develop a model of a PHC specialist (cardiovascular surgeon) in CVD and evaluate the clinical and managerial effectiveness of its implementation.Methods. The study (2016–2022) was conducted at the clinical diagnostic center of the Central Clinical Hospital “Russian Railways-Medicine” (Moscow), “SM-Clinic” (Moscow) and Department of Health Organization, Medication Provision, Medical Technologies and Hygiene of the Medical institute RUDN University. The subject of the study is the competencies and skills of a cardiovascular surgeon in primary care. The development of a model of a PHC specialist was carried out on the basis of personal improvement and integration of professional competencies and skills of cardiovascular surgeons in the aspect of applying clinical management technology in CVD (Kicha D.I., Goloshchapov-Aksenov R.S., 2019). The study included patients over 65 years of age (n = 422). The mean age of the patients was 77±8.6 years. The subjects of the study were cardiovascular surgeons (n = 4) with ≥5 years of work experience. The effectiveness of the model was evaluated according to clinical and managerial indicators of achieving the goal in the implementation of the author's algorithm for the organizational and technological management of PHC (2020). The follow-up was 36 months. We compared the results of 2016–2018 – before the introduction of the model and 2019–2022 – period of use of the model. Research methods were as follows: content analysis, statistical, mathematical, analytical, comparative, expert. The t-White test was used to assess the significance. Differences in the compared parameters were considered significant at p<0.05.Results. The developed model of a PHC specialist included components of patient orientation, the time of primary and repeated outpatient consultations, competencies and skills, adherence to surgical care and long-term clinical management, informatization, automation and systematization of the PHC process, interdisciplinary integration, implementation of the PHC algorithm and assessment efficiency. The obtained performance of the model is confirmed by significant differences in the compared indicators for the periods of 2016–2017 and 2018–2022: an increase in the availability of surgical endovascular care for patients with advanced atherosclerosis from 7 to 100% and the commitment of cardiovascular surgeons to surgical care and long-term continuous clinical management for the basis of improving and integrating the skills and competencies of mastering surgical and endovascular treatment technologies (from 25 to 100%); decrease in the frequency of repeated hospitalizations of patients during 3 years from 33% to 13% (p<0.05) and ambulance calls from 9% to 0.13% (p<0.05), a decrease in the incidence of acute cardiovascular diseases – primary acute myocardial infarction from 12 to 0% (p<0.05) and recurrence of critical ischemia of the lower extremities from 36 to 0.1% (p<0.05). The 3-year survival of patients was 96%. The main cause of death (sudden) in 17 patients (mean age 85±1.03 years) was the progression of heart failure.Conclusion. The developed model of a PHC specialist in cardiovascular diseases is an effective component that contributes to 96% survival rate of elderly and senile patients during 3 years of follow-up.

Highlights. Using the big data databases of provided medical services belonging to the Territorial Compulsory Medical Insurance Fund and the Unified State Healthcare Information System (USHIS), clinical and statistical analysis of ambulatory follow-up of patients with coronary artery disease was carried out, an algorithm was developed and the effectiveness of the presented information management technology was determined.Aim. To assess and justify the developed information management technology for the quality management of ambulatory follow-up of patients with coronary artery disease (CAD) based on monitoring and analyzing electronic personified data on medical services.Methods. In 2018 the Territorial Compulsory Medical Insurance Fund (TCMIF), the Medical Information and Analytical Center (MIAC) and healthcare organizations of the Orenburg Region implemented information management technology to assess the quality of ambulatory follow-up in patients with CAD, which is based on big data analysis of medical services and information integration “emergency medical services (EMS), hospital-TCMIF + MIAC-polyclinic”. To assess the effectiveness of the technology, the proportion of patients with myocardial infarction (MI), death from coronary artery disease, emergency hospitalizations and emergency calls for angina pectoris were compared. The study involved   two groups of patients: 13 208 ambulatory patients with angina pectoris and 4017 patients without follow-up, according to  the  TCMIF  reports  in  2017.  Out of the 13,208 patients with angina pectoris in 2019, 10,205 patients with continued follow-up presented with the same clinical endpoints. Patients with these unfavorable outcomes in proportion to the total number of patients in each group in 2017 and 2019 were compared as well.Results. The developed and implemented information management technology led to an increase in the number of ambulatory patients with angina pectoris from 63 to 69%, with MI from 78 to 87%, and a reduction of emergency calls and emergency hospitalizations of patients with angina pectoris in the region in 2017 and 2019.Conclusion. Information quality management of ambulatory follow-up of patients with coronary artery disease using electronic personalized data on medical services increases the number of ambulatory patients with angina pectoris and myocardial infarction, and decreases the number of unfavorable outcomes of patients with angina pectoris.

Background. Patients with cardiovascular diseases (CVD) older than 70 years have low adherence to surgical treatment. Aim. To investigate the adherence of elder patients with CVD to surgical treatment and evaluate the effectiveness of endovascular care. Material and methods. In 20162020 on the basis of the vascular surgery department of the Central Clinical Hospital Russian Railways-Medicine (Moscow) and the Peoples' Friendship University of Russia standardized clinical interviewing of patients with surgical CVD (n=422, average age 76.117.2 years) was conducted. Patients were considered adherent to surgical treatment if more than in 90% of cases they agreed to undergo cardiovascular surgery. Endovascular operations were performed (100%). Evaluation of the endovascular treatment effectiveness was carried out according to the following criteria: reducing the degree of ischemia, the duration of hospital treatment, the frequency of hospitalizations during the year caused by the CVD progression, and two-year survival. The duration of patients supervision was 24 months. We compared the results of the years 20162017 (the period of mainly conservative treatment, group A, n=106) and the years 20182019 (the period of high surgical activity for CVD, group B, n=422 which included 106 patients from group A). Differences between the compared indicators were considered significant at p 0.05. Results. The adherence of patients over 70 years old to surgical CVD treatment was 99.5% if endovascular technology was suggested. The priority usage of endovascular care contributed to the growth of surgical activity in the vascular surgery department from 7 to 98.9% (p=0.0015), as well as high immediate and long-term (24 months) clinical efficiency (100 and 88%), and two-year survival of patients up to 100% (group B). The average duration of hospitalization for endovascular treatment was 5.10.11 days, for conservative treatment it was 8.43.6 days (p=0.02). The average number of hospitalizations per year for patients in group A was 3.1 times, in group B 1.6 times (p=0.0028). Conclusion. Endovascular care for CVD curing is an effective method of surgical treatment and promotes adherence of elder patients to surgical treatment.

Introduction. An important principle of improving cardiovascular care is to increase the compliance of patients to optimal drug therapy. Purpose. To identify compliance in patients with cardiovascular diseases to optimal drug therapy. Materials and methods. Direct continuous questioning of patients with cardiovascular diseases (n = 1,018) was carried out using a modified Morisky D. questionnaire (1986). The survey was carried out by cardiovascular surgeons (n = 3) of the Central Clinical Hospital "Russian Railways Medicine". The degree of adherence of patients to the implementation of the recommendations of doctors at the stage of the initial interview and in 6 and 24 months was compared (p < 0.05). Results. At the stage of the first consultation low compliance of patients to antihypertensive therapy (23.8%); high compliance to dual antiplatelet therapy was established in patients after endovascular arterials stenting (99%), anticoagulant therapy in patients with atrial fibrillation (86%) and hypoglycemic therapy in patients with diabetes (98%). After follow-up for six months, including the provision of endovascular and surgical care, compliance to optimal drug therapy in patients of all groups increased up to 99.9% (p < 0.05). After follow-up for 24 months, the compliance degree to antihypertensive and anticoagulant therapy slightly decreased to 93.8 and 97.5%, respectively (p > 0.05). Limitations. To assess compliance to the recommendations of doctors, the results of outpatient follow-up of one thousand eighteen patients with cardiovascular diseases over two years were analyzed, which is a sufficient reference sample. Conclusion. Compared with the initial consultation of patients, their compliance to optimal drug therapy increased during the 12 months of follow-up. Clinical management in the treatment-and-prophylactic process optimizes control over the effectiveness of the implementation of medical prescriptions, including self-control by patients of hemodynamic and other indicators. The formation of trusting relationships in the “doctor-patient” system is the most important principle of the continuity compliance of clinical management of the process of improving public health.