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.

Инфаркт миокарда в пожилом возрасте является ведущей патологией и причиной смертельных случаев. Цель исследования - оценка прогностической значимости и информативности кардиомаркеров крови у пожилых больных с инфарктом миокарда. Исследованы кардиомаркеры у 107 больных 65-75 лет с инфарктом миокарда и у 83 больных 50-60 лет иммунохроматографическим, биолюминесцентным методами и с помощью электрофореза на ацетате целлюлозы с последующим расчётом информативности и прогностических коэффициентов. Контрольную группу составили 95 человек 65-75 лет без инфаркта миокарда. Наибольшей информативностью и прогностической значимостью у пожилых пациентов с инфарктом миокарда обладают тропонин Т , мозговой натрийуретический пептид, глюкозо-6-фосфатдегидрогеназа и лактатдегидрогеназа-1. Применение данных кардиомаркеров улучшит диагностику и выделение пациентов с инфарктом миокарда в группу высокого риска. Myocardial infarction in old age is the leading pathology and cause of deaths. The aim of the study was to evaluate the prognostic significance and informative value of cardiac markers of blood in elderly patients with myocardial infarction. The study of cardiac markers in 107 patients with myocardial infarction at the age of 65-75 years and in 83 patients with myocardial infarction at the age of 50-60 years was carried out by immunochromatographic, bioluminescent methods and by electrophoresis on cellulose acetate, followed by the calculation of informativeness and prognostic coefficients. 95 persons aged 65-75 years without myocardial infarction served as control. Troponin T , brain natriuretic peptide, glucose-6-phosphate dehydrogenase and lactate dehydrogenase-1 have the most informative and prognostic significance in elderly patients with myocardial infarction. The use of these cardiac markers will improve the diagnosis and isolation of patients with myocardial infarction at high risk.

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. The basis for improving the quality of medical care is the arrangement of algorithms for clinical processes. The choice of a clinical and organizational solution for cardiovascular diseases in groups of older age patients at the stage of primary healthcare is a complex medical and economic task that requires maintaining the balance of efficiency, safety and quality of life in the "patient – risks – survival – economic efficiency" system. The development of an algorithm for making clinical and organizational decisions concerning cardiovascular diseases in elderly patients to improve the effectiveness of primary healthcare is an urgent health issue.Aim. To develop and evaluate the effectiveness of the algorithm for making clinical and organizational decisions at the primary healthcare stage for elder patients with cardiovascular diseases.Methods. The bases for the study were conducted in 2016–2020 at the Vascular Surgery Department of Peoples Friendship University of Russia and the Central Clinical Hospital “RZD-Medicine”. The object of the study was the patients with cardiovascular diseases (n = 422), mean age 76.11±7.2 years old. The subject of the study was cardiovascular surgeons (n = 4) experienced in surgical and endovascular technology. The algorithm was based on the content analysis of scientific publications (n = 27), clinical practice, the organizational and technological algorithm of PHC (primary healthcare) developed by Abramov A.Yu. and the colleagues in 2020 and the recommendations for the care of the elderly people with polymorbidity developed by the American Geriatric Society (2012). The medical, social and clinical effectiveness as well as the economic results of inpatient treatment were evaluated. The periods before and after the implementation of the algorithm in 2016–2017 and 2018–2020 were compared. Content analysis, analytical, statistical, mathematical, comparative, and expert research methods were applied.Results. The developed PHC (primary healthcare) algorithm contributed to the high level of accessibility of endovascular care (100%). Cardiovascular surgeons positively assessed the possibility of providing surgical care in 100% of cases and patient adherence to surgical treatment (99.5%). In 2016–2017 and 2018–2020 the surgical activity of the vascular surgery department significantly increased from 7 to 98.9%, the average bed-day decreased from 9.5 to 6.8 days and the postoperative bed-day from 7.2 to 4.12 days, the frequency of repeated hospitalizations in the hospital decreased during the year from 3.1±0.2 to 1.6±0.4 times, the incidence of primary acute myocardial infarction from 12 to 0% and relapses of critical ischemia of the lower extremities from 36 to 2%. The average cost of direct medical costs for the treatment of one patient during the year in the main and control groups did not differ significantly, 4 086$ (USA) и 3 887$ (USA), respectively.Conclusion. The PHC development and experience algorithm indicates the increase in the medical, social and clinical effectiveness of medical care for cardiovascular diseases in patients of older age groups and helps to reduce the direct costs of inpatient care.