Implemented models and elements for heart failure care in the regions of the Russian Federation: prospects for transformation into regional cardiovascular risk management systems

Шляхто, Е. В.; Звартау, Надежда; Villevalde, S.; Яковлев, А. Н.; Soloveva, A.; Avdonina, N.; Медведева, Е. А.; Ендубаева, Г. В.; Карлина, В. А.; Соловьев, А. Е.; Федоренко, А. А.; Зайцев, В. В.; Панарина, С. А.; Ерастов, А. М.; Vinogradova, N. G.; Фомин, И. В.; Рагозина, Н. П.; Шлосберг, Ж. А.; Моисеева, О. М.; Ситникова, М. Ю.

doi:10.15829/1560-4071-2020-4-3792

Cited by 20 publications

(9 citation statements)

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“…Формирование "бесшовной" модели ведения пациентов с хроническими ССЗ, в особенности пожилых и коморбидных, получающих медицинскую по-мощь в различных лечебных учреждениях и у различных специалистов, может снизить смертность от БСК [19]. Одним из решений является создание в каждом регионе системы управления сердечно-сосудистыми рисками, важным компонентом которой является организация преемственности между стационарным и амбулаторным этапами оказания медицинской помощи [20].…”

Section: наблюдение кардиологом на амбулаторном этапе и прогноз больнunclassified

Association of medical staffing and outcomes in cardiovascular diseases

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Raised life expectancy of patients with cardiovascular diseases (CVD), due to continuous progress in drug treatment options and widespread use of innovate technologies, increase the burden of CVD on healthcare system. The development of human resources by highly qualified specialists is of fundamental importance. For the rational use of human resources to achieve the targets of federal project on the prevention of cardiovascular diseases, it is necessary not only to analyze the actual situation with medical staffing, but also the potential effects of staff shortages and imbalances on mortality. The review presents evidence of associations between staffing and quality of care and CVD outcomes.

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Section: наблюдение кардиологом на амбулаторном этапе и прогноз больнunclassified

Association of medical staffing and outcomes in cardiovascular diseases

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“…Эффективная система выявления и длительного наблюдения пациентов с ХСН в учреждениях первичного звена, в т. ч. реализация принципа "бесшовного" ведения с преемственностью медицинской помощи между стационарным и амбулаторным этапами, своевременным выявлением пациентов с ХСН и взятие на диспансерное наблюдение, имеют определяющее значение в стратегии снижения смертнос ти [23,24]. Реализация подобной модели в РФ по сравнению со стандартным ведением ассоциировалась со снижением риска смерти от всех причин на 21,2% в течение 2 лет [25].…”

Section: предлагаемые изменения в формах федерального статистическогоunclassified

Assessment of prevalence and monitoring of outcomes in patients with heart failure in Russia

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“…Специализированная медицинская помощь пациентам с ХСН активно развивается в странах Европы, США, Канаде, Австралии. В Российской Федерации (РФ) есть опыт организации и работы специализированной медицинской помощи больным ХСН [16]. На примере работы Городского центра лечения ХСН (ЦХСН) г. Нижнего Новгорода в данной статье рассмотрены обоснование и предпосылки формирования данной службы.…”

Section: Introductionunclassified

Rationale of specialized medical care for patients with chronic heart failure in the Russian Federation

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Vinogradova

2020

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Objectives: to determine the causes of ineffective observation and poor prognosis in patients undergoing ADHF, in real clinical practice and to consider the basics of the formation of specialized medical care for patients with heart failure (HF).Materials and methods: the study was conducted based on the City Center for the treatment of heart failure (center HF), N. Novgorod. The study consistently included 942 patients with heart failure (HF) at the age of 18 years and older who underwent ADHF and received inpatient treatment in center HF between March 4, 2016 and March 3, 2017. Based on the decisions of patients to continue outpatient monitoring in center HF, two groups of patients were distinguished: patients who continued to be monitored in center HF (group I, n = 510) and patients who continued to be monitored in outpatient clinics at the place of residence (group II, n = 432). The assessment of adherence to treatment, overall mortality, survival and re-admission to a depth of two years of observation was carried out. Statistical data processing was performed using Statistica 7.0 for Windows and the software package R.Results: all patients in the study groups had high comorbidity. Group 2 patients turned out to be statistically significantly older, more often had III functional class (FC) HF, lower the baseline test score of 6-minute walk, and higher the baseline clinical assessment scale. After 2 years of follow-up in group II, there was a significant deterioration in adherence to basic therapy of HF compared with group I. According to the results of multifactorial proportional risk Cox models, it was shown that observation of patients in the group 1 is an independent factor increasing the risk of overall mortality by 2.8 times by the end of the second year of observation. Survival after two years of follow-up was: in group I — 89.8 %, and in group II — 70.1 % of patients (OR = 0.3, 95 % CI 0.2 – 0.4; p1/2 < 0.001). After two years of follow-up, the proportion of re-hospitalized patients in group II was greater (78.0 % of patients) versus group 1 (50.6 % of patients, OR = 3.5, 95 % CI 2.6 – 4.6; p1/2 <0.001). The independent risk of re-hospitalization according to multinominal logit regression was 3.4 times higher in group II and 2.4 times for III – IV FC HF. Conclusions: the inclusion of patients with HF in the system of specialized medical care improves adherence to treatment, prognosis of life and reduces the risk of repeated hospitalizations. Patients of an older age and with an initially greater clinical severity refused specialized supervision in center HF.

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Implemented models and elements for heart failure care in the regions of the Russian Federation: prospects for transformation into regional cardiovascular risk management systems

Cited by 20 publications

References 15 publications

Association of medical staffing and outcomes in cardiovascular diseases

Association of medical staffing and outcomes in cardiovascular diseases

Assessment of prevalence and monitoring of outcomes in patients with heart failure in Russia

Rationale of specialized medical care for patients with chronic heart failure in the Russian Federation

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