Acute Coronary Syndrome during the Pandemic New Coronavirus Infection.

The experience of managing patients with COVID-19 around the world has shown that, although respiratory symptoms predominate during the manifestation of infection, then many patients can develop serious damage to the cardiovascular system. However, coronary artery disease (CHD) remains the leading cause of death worldwide. The purpose of the review is to clarify the possible pathogenetic links between COVID-19 and acute coronary syndrome (ACS), taking into account which will help to optimize the management of patients with comorbid pathology. Among the body's responses to SARS-CoV-2 infection, which increase the likelihood of developing ACS, the role of systemic inflammation, the quintessence of which is a "cytokine storm" that can destabilize an atherosclerotic plaque is discussed. Coagulopathy, typical for patients with Covid-19, is based on immunothrombosis, caused by a complex interaction between neutrophilic extracellular traps and von Willebrandt factor in conditions of systemic inflammation. The implementation of a modern strategy for managing patients with ACS, focused on the priority of percutaneous interventions (PCI), during a pandemic is experiencing great difficulties due to the formation of time delays before the start of invasive procedures due to the epidemiological situation. Despite this, the current European, American and Russian recommendations for the management of infected patients with ACS confirm the inviolability of the position of PCI as the first choice for treating patients with ACS and the undesirability of replacing invasive treatment with thrombolysis.Copyright © 2023 Stolichnaya Izdatelskaya Kompaniya. All rights reserved.

Acute Coronary Syndrome during the Pandemic New Coronavirus Infection

The experience of managing patients with COVID-19 around the world has shown that, although respiratory symptoms predominate during the man-ifestation of infection, then many patients can develop serious damage to the cardiovascular system. However, coronary artery disease (CHD) remains the leading cause of death worldwide. The purpose of the review is to clarify the possible pathogenetic links between COVID-19 and acute coronary syndrome (ACS), taking into account which will help to optimize the management of patients with comorbid pathology. Among the body's responses to SARS-CoV-2 infection, which increase the likelihood of developing ACS, the role of systemic inflammation, the quintessence of which is a "cytokine storm" that can destabilize an atherosclerotic plaque is discussed. Coagulopathy, typical for patients with Covid-19, is based on immunothrombosis, caused by a complex interaction between neutrophilic extracellular traps and von Willebrandt factor in conditions of systemic inflammation. The im-plementation of a modern strategy for managing patients with ACS, focused on the priority of percutaneous interventions (PCI), during a pandemic is experiencing great difficulties due to the formation of time delays before the start of invasive procedures due to the epidemiological situation. Despite this, the current European, American and Russian recommendations for the management of infected patients with ACS confirm the inviolability of the position of PCI as the first choice for treating patients with ACS and the undesirability of replacing invasive treatment with thrombolysis.

Acute Coronary Syndrome during the Pandemic New Coronavirus Infection.

The experience of managing patients with COVID-19 around the world has shown that, although respiratory symptoms predominate during the manifestation of infection, then many patients can develop serious damage to the cardiovascular system. However, coronary artery disease (CHD) remains the leading cause of death worldwide. The purpose of the review is to clarify the possible pathogenetic links between COVID-19 and acute coronary syndrome (ACS), taking into account which will help to optimize the management of patients with comorbid pathology. Among the body's responses to SARS-CoV-2 infection, which increase the likelihood of developing ACS, the role of systemic inflammation, the quintessence of which is a "cytokine storm" that can destabilize an atherosclerotic plaque is discussed. Coagulopathy, typical for patients with Covid-19, is based on immunothrombosis, caused by a complex interaction between neutrophilic extracellular traps and von Willebrandt factor in conditions of systemic inflammation. The implementation of a modern strategy for managing patients with ACS, focused on the priority of percutaneous interventions (PCI), during a pandemic is experiencing great difficulties due to the formation of time delays before the start of invasive procedures due to the epidemiological situation. Despite this, the current European, American and Russian recommendations for the management of infected patients with ACS confirm the inviolability of the position of PCI as the first choice for treating patients with ACS and the undesirability of replacing invasive treatment with thrombolysis.Copyright © 2023 Stolichnaya Izdatelskaya Kompaniya. All rights reserved.

In-hospital outcomes of ST elevation myocardial infarction in post-COVID-19 patients.

Aim. To study clinical and anamnestic data, as well as inhospital outcomes in patients with ST elevation myocardial infarction (STEMI) with prior coronavirus disease 2019 (COVID-19) compared with previously uninfected STEMI patients. Material and methods. This prospective study included 181 patients treated for STEMI. The patients were divided into 2 groups, depending on the anti-SARS-CoV-2 IgG titer as follows: the main group included 62 seropositive patients, while the control group - 119 seronegative patients without prior COVID-19. Anamnesis, clinical and paraclinical examination, including electrocardiography, echocardiography, coronary angiography, were performed. Mortality and incidence of STEMI complications at the hospital stage were analyzed. Results. The mean age of the patients was 62,6+/-12,3 years. The vast majority were men (69,1% (n=125)). The median time from the onset of COVID-19 manifestations to STEMI was 60,00 [45,00;83,00] days. According to, the patients of both groups were comparable the severity of circulatory failure (p>0,05). Coronary angiography found that in patients of the main group, Thrombolysis In Myocardial Infarction (TIMI) score of 0-1 in the infarct-related artery was recorded much less frequently (62,9% (n=39) vs, 77,3% (n=92), p=0,0397). Patients of the main group demonstrated a lower concentration of leukocytes (9,30*109/l [7,80;11,40] vs 10,70*109/l [8,40;14,00], p=0,0065), higher levels of C-reactive protein (21,5 mg/L [9,1;55,8] vs 10,2 mg/L [5,1;20,5], p=0,0002) and troponin I (9,6 ng/mL [2,2;26,0] vs 7,6 ng/mL [2,2;11,5], p=0,0486). Lethal outcome was recorded in 6,5% (n=4) of cases in the main group and 8,4% (n=10) in the control group (p=0,6409). Both groups were comparable in terms of the incidence of complications (recurrent myocardial infarction, ventricular fibrillation, complete atrioventricular block, stroke, gastrointestinal bleeding) during hospitalization (p>0,05). Conclusion. Patients with STEMI after COVID-19, despite a more burdened history and higher levels of C-reactive protein and troponin I, compared with STEMI patients without COVID-19, did not differ significantly in clinical status, morbidity, and inhospital mortality.Copyright © 2023, Silicea-Poligraf. All rights reserved.

VACCINATION against NEW CORONAVIRUS INFECTION in PATIENTS with CARDIOVASCULAR and AUTOIMMUNE DISEASES.

The review article is devoted to a discussion of the issues of vaccination against a new coronavirus infection in patients with cardiovascular and autoimmune diseases. Presented at the time of this writing are data on domestic vaccines safety in the Russian Federation: combined vector vaccines "Gam-COVID-Vac" and "Gam-COVID-Vac-Lyo", peptide-based vaccine "EpiVacCorona", concentrated, purified and inactivated whole-virion "KoviVac" vaccine, and a standalone vaccine/booster shot "Sputnik Light". The analysis of the main contraindication applicable to the vaccines in different categories of patients has been carried out. A number of consensus documents published by Russian and foreign professional medical associations and communities on the issues of vaccination of patients with cardiovascular and autoimmune diseases are considered in detail.Copyright © 2021 Infectious Diseases: News, Opinions, Training. All rights reserved.

Association of HLA Class I Genotype with Mortality in Patients with Diabetes Mellitus and COVID-19.

Numerous studies showed that diabetes mellitus (DM) increases the risk of death from COVID-19 by five times. It is generally accepted that the high lethality of COVID-19 against the background of DM is due to the main complications of this disease: micro- and macroangiopathies, as well as heart and kidney failure. In addition, it was shown that acute respiratory viral infection increases the production of interferon gamma, increases muscle resistance to insulin, and modulates the activity of effector CD8+ T cells. The ability of CD8+ T cells to recognize SARS-CoV-2-infected cells depends not only on humoral factors but also on individual genetic characteristics, including the individual set of major histocompatibility complex class I (MHC-I) molecules. In this study, the relationship of the MHC-I genotype of patients with DM aged less than 60 years with the outcome of COVID-19 was studied using a sample of 222 patients. It was shown that lethal outcomes of COVID-19 in patients with DM are associated with the low affinity of the interaction of an individual set of MHC-I molecules with SARS-CoV-2 peptides.

Management of patients with hypertension, coronary heart disease and chronic heart failure during the COVID-19 pandemic in the primary care setting.

On December 1, 2021, a meeting of the Council of experts on the treatment of hypertension, coronary heart disease, and chronic heart failure during the COVID-19 pandemic was held remotely to adjust and adapt current approaches to outpatient treatment of the above pathologies under the current epidemiological situation. The meeting was attended by leading Russian specialists from federal medical research centers of cardiology and therapy.Copyright © 2022 All-Russian Public Organization Antihypertensive League. All rights reserved.

[Features of the course of non-ST elevation myocardial infarction in patients with a history of COVID-19].

Aim      To study the clinical course of non-ST segment elevation myocardial infarction (NSTEMI) in hospitalized patients after COVID-19 and to evaluate the effect of baseline characteristics of patients on the risk of complications.Material and methods  The study included 209 patients with NSTEMI; 104 of them had had COVID-19. The course of myocardial infarction (MI) was analyzed at the hospital stage, including evaluation of the incidence rate of complications (fatal outcome, recurrent MI, life-threatening arrhythmias and conduction disorders, pulmonary edema, cardiogenic shock, ischemic stroke, gastrointestinal bleeding).Results Mean age of patients after COVID-19 was 61.8±12.2 years vs. 69.0±13.0 in the comparison group (p<0.0001). The groups were comparable by risk factors, clinical data, and severity of coronary damage. Among those who have had СOVID-19, there were fewer patients of the GRACE high risk group (55.8 % vs. 74.3 %; p<0.05). Convalescent COVID-19 patients had higher levels of C-reactive protein and troponin I (p<0.05). The groups did not significantly differ in the incidence of unfavorable NSTEMI course (p>0.05). However, effects of individual factors (postinfarction cardiosclerosis, atrial fibrillation, decreased SpO2, red blood cell concentration, increased plasma glucose) on the risk of complications were significantly greater for patients after COVID-19 than for the control group (p<0.05).Conclusion      Patients with NSTEMI, despite differences in clinical history and laboratory data, are characterized by a similar risk of death at the hospital stage, regardless of the past COVID-19. Despite the absence of statistically significant differences in the incidence of in-hospital complications, in general, post-COVID-19 patients showed a higher risk of complicated course of NSTEMI compared to patients who had not have COVID-19. In addition, for this category of patients, new factors were identified that previously did not exert a clinically significant effect on the incidence of complications: female gender, concentration of IgG to SARS-CoV-2 ≥200.0 U/l, concentration of С-reactive protein ≥40.0 mg/l, total protein <65 g/l. These results can be used for additional stratification of risk for cardiovascular complications in patients with MI and also for development of individual protocols for evaluation and management of NSTEMI patients with a history of COVID-19.

Clinical and Anamnestic Characteristics, Cardiovascular Pharmacotherapy and Long-term Outcomes in Multimorbid Patients after COVID-19

Aim. To study the clinical and anamnestic characteristics, pharmacotherapy of cardiovascular diseases (CVD) and long-term outcomes in post-COVID-19 patients with cardiovascular multimorbidity (CVMM), enrolled in the prospective hospital registry. Material and methods. In patients with confirmed COVID-19 included in the TARGET-VIP registry, the CVMM criterion was the presence of two or more CVDs: arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF), atrial fibrillation (AF). There were 163 patients in the CVMM group and 382 - in the group without CVD. The information was obtained initially from hospital history sheet, and afterwards - from a telephone survey of patients after 30-60 days, 6 and 12 months, from electronic databases. The follow-up period was 13.0 +/- 1.5 months.Results. The age of post-COVID patients with CVMM was 73.7 +/- 9.6 years, without CVD - 49.4 +/- 12.4 years (p<0.001), the proportion of men was 53.9% and 58.4% (p=0.34). In the group with CVMM the majority of patients had AH (92.3-93.3%), CHD (90.4-91.4%), and minority - CHF (42.7-46.0%) and AF (42.9-43.4%). The combination of 3-4 CVDs prevailed (58.9-60.3%). The proportion of cases of chronic non-cardiac pathologies was higher in the CVMM group (80.9%) compared to the group without CVD (36.7%;p<0.001). The frequency of proper cardiovascular pharmacotherapy during the follow-up period decreased from 56.8% to 51.3% (p for trend = 0.18). The frequency of anticoagulant therapy in AF decreased significantly: from 89.1% at the discharge from the hospital to 56.4% after 30-60 days (p=0.001), 57.1% and 53.6% after 6 and 12 months of monitoring (p for a trend <0.001). There were no other significant changes in the frequency of other kinds of the proper cardiovascular pharmacotherapy (p>0.05). There were higher rate of all-cause mortality among patients with CMMM (12.9% vs 2.9%, p<0.001) as well as rates of hospitalization (34.7% and 9.9%, p<0.001) and non-fatal myocardial infarction (MI) - 2.5% vs 0.5% (p=0.048). The proportion of new cases of CVD in the groups with CVMM and without CVD was 5.5% and 3.7% (p=0.33). The incidence of acute respiratory viral infection (ARVI)/influenza was higher in the group without CVD - 28.3% vs 19.0% (p=0.02). The proportion of cases of recurrent COVID-19 in groups with CVMM and without CVD was 3.7 % and 1.8% (p=0.19).Conclusion. Post COVID-19 patients with CVMM were older and had the bigger number of chronic non-cardiac diseases than patients without CVD. The quality of cardiovascular pharmacotherapy in patients with CVMM was insufficient at the discharge from the hospital with following non-significant decrease during 12 months of follow-up. The frequency of anticoagulant therapy in AF decreased by 1.6 times after 30-60 days and by 1.7 times during the year of follow-up. The proportion of new cases of CVD was 5.5% and 3.7% with no significant differences between compared groups. The rate of all-cause mortality, hospitalizations and non-fatal MI was significantly higher in patients with CVMM, but the frequency of ARVI/influenza was significantly higher in patients without CVD. Recurrent COVID-19 was registered in 3.7% and 1.8% of cases, there were no significant differences be-tween compared groups.

Management of patients with hypertension, coronary heart disease and chronic heart failure during the COVID-19 pandemic in the primary care setting

On December 1, 2021, a meeting of the Council of experts on the treatment of hypertension, coronary heart disease, and chronic heart failure during the COVID-19 pandemic was held remotely to adjust and adapt current approaches to outpatient treatment of the above pathologies under the current epidemiological situation. The meeting was attended by leading Russian specialists from federal medical research centers of cardiology and therapy. Copyright © 2022 All-Russian Public Organization Antihypertensive League. All rights reserved.

Long-term follow-up of patients after COVID-19: adherence to SARS-CoV-2 vaccination and immune status

Objective. To assess the adherence of COVID-19 convalescents to vaccination against SARS-CoV-2 and immune status based on long-term follow-up (12 months or more after hospital discharge). Material and methods. Using the TARGET-VIP registry, 775 patients (age 57.5+/-1.4 years;50.6% males) with the in-hospital diagnosis of COVID-19 were followed for 13.7+/-3.0 months after discharge. Comparison groups included 190 (24.5%) subjects vaccinated against SARS-CoV-2 and 585 (75.5%) unvaccinated during the follow-up period. Immune status was assessed in a representative sample of 283 (36.5%) patients (age 56.9+/-12.7 years, 44.9% males) who came for outpatient visits 14.6+/-4.1 months after hospital discharge, including 97 (34.3%) vaccinated and 186 (65.7%) unvaccinated against SARS-CoV-2. Results. No significant differences were found between the SARS-CoV-2 vaccinated and unvaccinated groups in age, gender char-acteristics, cardiovascular disease rate, chronic non-cardiac disease rate, and proportion of smokers. In the unvaccinated group, a higher proportion of patients with a history of ICU treatment for COVID-19 and/or grade 3-4 lung injury measured by CT scans was observed: 55.0% versus 46.8% (p=0.048). The vaccinated group included less active smokers: 3.7% versus 6.0% (p=0.22). Among the patients who came to the visit, antibody titer of IgG type N was increased in 50.4% of cases, and antibody titer of IgG type S (quantitatively) - in 98.6% of cases. After 14.6+/-4.1 months of follow-up, the SARS-CoV-2 vaccinated group (12.3+/-2.7 months after COVID-19) had higher IgG type S levels (505+/-103 versus 376+/-171 BAU/mL;p<0.001) compared with unvaccinated patients and no statistically significant difference in IgG (type N) and IgM titers. The SARS-CoV-2 vaccinated group had significantly higher rates of influenza vaccination both before COVID-19 (34.8% versus 21.9%;p=0.0004) and after hospitalization for COVID-19 (37.0% versus 15.0%;p<0.0001) compared with the unvaccinated group. After COVID-19, compared to the period before hospitalization, the proportion of vaccinated against influenza in the group vaccinated against SARS-CoV-2 increased (from 34.8% to 37.0%;p=0.65) and decreased in the group unvaccinated against SARS-CoV-2 (from 21.9% to 15.0%;p=0.003). Conclusion. The study showed that only 24.5% of COVID-19 survivors were subsequently vaccinated against SARS-CoV-2 over a fol-low-up period of 13.7+/-3.0 months. One year after hospital discharge, 50.4% of patients had elevated IgG type N titer, and 98.6% of patients had high IgG type S titer, significantly higher in vaccinated patients. Adherence to influenza vaccination after hospitalization for COVID-19 increased in patients subsequently vaccinated against SARS-CoV-2 and decreased in unvaccinated patients. Copyright © 2022, Media Sphera Publishing Group. All rights reserved.

Comparative assessment of efficacy and immunogenicity of Gam-COVID-Vac and CoviVac vaccines against SARS-CoV-2

The medical community is interested in the duration of immune protection and the level of specific antibodies (AB) that can pre-vent reinfection with SARS-CoV-2. Objective. To perform a comparative evaluation of efficacy and immunogenicity of Gam-COVID-Vac and CoviVac vaccines against SARS-CoV-2 in a prospective observational study. Material and methods. The following vaccines were used for the vaccination of subjects (n=3322) aged 18 years and older: Gam-COVID-Vac - 1,622 (48.8%) subjects (group I), CoviVac - 1,700 (51.2%) subjects (group II). Vaccinated subjects were fol-lowed up for 6 study visits: before the 1st component of the vaccine, before the 2nd component of the vaccine, 42 days, 3 months, 6 months, and 12 months after the 1st component of the vaccine. Immunoglobulin G (IgG) levels of AB to S protein were compared after the injection of Gam-COVID-Vac and CoviVac vaccines using an enzyme immunoassay. Statistical processing of the obtained data was performed using IBM SPSS Statistics v. 24 and MedCalc v. 20.104 software. Results. Group I subjects showed an increase in specific AB (IgG) levels to SARS-CoV-2 S protein from visit 1 to visits 2 and 3 (p<0.05). In more extended follow-up periods (visits 5, 6), AB levels in groups I and II did not differ significantly and remained sufficiently high by visit 6. Within one year of follow-up, the incidence of COVID-19 (confirmed by polymerase chain reaction) was significantly (p<0.01) lower in the Gam-COVID-Vac group (group I): 22.2% vs. 45.2% in the CoviVac group (group II). The maximum number of days (p<0.05) before the COVID-19 infection was observed in those vaccinated with Gam-COVID-Vac (221 days) compared to those immunized with CoviVac (159 days). Conclusion. The Gam-COVID-Vac vaccine is more effective against COVID-19 and induces a more rapid response of the hu-moral immune system than the CoviVac vaccine. However, the duration of the humoral immune response after administration of Gam-COVID-Vac and CoviVac was similar. Copyright © 2022, Media Sphera Publishing Group. All rights reserved.

School-Aged Children's Physical Activity during the COVID-19 pandemic: results of the Russian part of the international study in 9 European countries

AIM: Assessment of the School-Aged Children's Physical Activity (PA) in the Russian Federation before and during the COVID-19 pandemic and its compliance with the WHO recommendations. METHODS: This was a multi-national cross-sectional study. More than 24,000 children aged 6–18 years from nine European countries (Hungary, Spain, Portugal, Russian Federation, Poland, Italy, Slovenia, Germany, and Denmark) participated in the online survey. In the Russian Federation, the online survey was conducted from 28th January to 10th February 2021. The questionnaire was completed by 13,392 children or their parents from 64 Russian regions. In total, 11,763 respondents were included in the study, i.e., 50.8% boys (n=5985) and 49.2% girls (n=5778), 72% urban residents, and 28% rural residents. The mean age (M±SD) was 11.24±2.93 years. The questionnaire contained five sections — questions about the socio-demographic data;physical activity, play, or sedentary behavior in the last seven days;comparison of the child's PA at the moment with PA during the first wave of COVID-19;comparison of the child's PA at the moment with the PA before the COVID-19 pandemic;compliance with WHO global recommendations on PA and sedentary lifestyle;questions about the socio-demographic background of the parent/ guardian. Survey data were obtained via online platforms. Meeting the WHO Global Guidelines was defined as 60-minute MVPA per day for a week;total screen time of fewer than 2 hours per day. Data were presented as absolute values and percentages. Chi-Square (χ2) test was used to compare percentages to identify significant differences. A p-value of 0.05 indicated statistical significance. RESULTS: Outcomes of this online survey revealed that only a small percentage of children followed the PA guidelines. Therefore, the proportion of children following the WHO recommendations was only 7.5%. An increase in screen time on weekdays during the pandemic was observed in 21.9% of the participants, and on weekends — 20.3%. CONCLUSION: These results should be used to develop and implement targeted measures to prevent low levels FA among school-age children. © Eco-Vector, 2022.

Prevalence of non-alcoholic fatty liver disease among the working-age population: associations with socio-demographic indicators and behavioral risk factors (ESSE RF-2 data)

Aim. To assess the prevalence of non-alcoholic fatty liver disease (NAFLD) using the liver obesity index - FLI (Fatty Liver Index), and to study its associations with socio-demographic indicators and behavioral risk factors for NAFLD. Material and methods. The data from the multicenter ESSE-RF study (Epidemiology of cardiovascular diseases in the regions of the Russian Federation) - samples from the unorganized male and female population aged 25-64 years were used. 5,161 respondents were included, of which 2,275 (44,1%) were men. To assess the prevalence of NAFLD, the liver obesity index FLI was used, calculated according to the formula by Bedogni G, et al. (2006). A high FLI index =60 was considered a predictor of liver steatosis. Results. High FLI =60 was detected in 38,5% of men and 26,6% of women. Multivariate analysis of associations of high FLI index in men and women showed a strong relationship with age: men - odds ratio (OR) 5,01, 95% confidence interval (CI): 3,82-6,59 (p<0,0001) and women - OR 8,58, 95% CI: 6,39-11,64 (p<0,0001), living in rural areas: men - OR 1,32, 95% CI: 1,06-1,63 (p=0,011) and women - OR 1,4, 95% CI: 1,15-1,71 (p=0,001). The FLI index >=60 was significantly associated with low physical activity (p=0,001) in men and current smoking in women (p=0,013). Conclusion. A high FLI index >=60 is most common among men, significantly associated with age, living in rural areas, currently smoking women, and low physical activity men. Higher education, in relation to FLI >=60, had a protective effect on women. Copyright © 2022 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.

Clinical and Anamnestic Characteristics, Cardiovascular Pharmacotherapy and Long-term Outcomes in Multimorbid Patients after COVID-19

Aim. To study the clinical and anamnestic characteristics, pharmacotherapy of cardiovascular diseases (CVD) and long-term outcomes in post-COVID-19 patients with cardiovascular multimorbidity (CVMM), enrolled in the prospective hospital registry. Material and methods. In patients with confirmed COVID-19 included in the TARGET-VIP registry, the CVMM criterion was the presence of two or more CVDs: arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF), atrial fibrillation (AF). There were 163 patients in the CVMM group and 382 - in the group without CVD. The information was obtained initially from hospital history sheet, and afterwards - from a telephone survey of patients after 30-60 days, 6 and 12 months, from electronic databases. The follow-up period was 13.0+/-1.5 months. Results. The age of post-COVID patients with CVMM was 73.7+/-9.6 years, without CVD - 49.4+/-12.4 years (p<0.001), the proportion of men was 53.9% and 58.4% (p=0.34). In the group with CVMM the majority of patients had AH (92.3-93.3%), CHD (90.4-91.4%), and minority - CHF (42.7-46.0%) and AF (42.9-43.4%). The combination of 3-4 CVDs prevailed (58.9-60.3%). The proportion of cases of chronic non-cardiac pathologies was higher in the CVMM group (80.9%) compared to the group without CVD (36.7%;p<0.001). The frequency of proper cardiovascular pharmacotherapy during the follow-up period decreased from 56.8% to 51.3% (p for trend = 0.18). The frequency of anticoagulant therapy in AF decreased significantly: from 89.1% at the discharge from the hospital to 56.4% after 30-60 days (p=0.001), 57.1% and 53.6% after 6 and 12 months of monitoring (p for a trend <0.001). There were no other significant changes in the frequency of other kinds of the proper cardiovascular pharmacotherapy (p>0.05). There were higher rate of all-cause mortality among patients with CMMM (12.9% vs 2.9%, p<0.001) as well as rates of hospitalization (34.7% and 9.9%, p<0.001) and non-fatal myocardial infarction (MI) - 2.5% vs 0.5% (p=0.048). The proportion of new cases of CVD in the groups with CVMM and without CVD was 5.5% and 3.7% (p=0.33). The incidence of acute respiratory viral infection (ARVI)/influenza was higher in the group without CVD - 28.3% vs 19.0% (p=0.02). The proportion of cases of recurrent COVID-19 in groups with CVMM and without CVD was 3.7 % and 1.8% (p=0.19). Conclusion. Post COVID-19 patients with CVMM were older and had the bigger number of chronic non-cardiac diseases than patients without CVD. The quality of cardiovascular pharmacotherapy in patients with CVMM was insufficient at the discharge from the hospital with following non-significant decrease during 12 months of follow-up. The frequency of anticoagulant therapy in AF decreased by 1.6 times after 30-60 days and by 1.7 times during the year of follow-up. The proportion of new cases of CVD was 5.5% and 3.7% with no significant differences between compared groups. The rate of all-cause mortality, hospitalizations and non-fatal MI was significantly higher in patients with CVMM, but the frequency of ARVI/influenza was significantly higher in patients without CVD. Recurrent COVID-19 was registered in 3.7% and 1.8% of cases, there were no significant differences between compared groups. Copyright © 2022 Stolichnaya Izdatelskaya Kompaniya. All rights reserved.

Dynamics of Regional Mortality Rates From Cardiac Causes in Russia 2019-2020.

Aim      To analyze the dynamics of standardized mortality ratios (SMR) (2019-2020) for the cardiological causes indicated as the primary (original) cause of death, in regions of the Russian Federation, based on the RF State Statistics Service Brief Nomenclature of Causes of Death (RFSSS BNCD). Reports have indicated substantial changes in the indexes and structure of mortality since the beginning of the COVID-19 pandemic in many countries.Material and methods  RFSSS data on numbers of deaths were analyzed according to BNCD and mid-year population in single year of age groups in 2019 and 2020. SMRs were determined for 23 cardiological causes of death listed in the BNSD in a separate line; the average regional SMR value and the standard deviation were provided; and SMRs were compared both among 4 groups (with a previously described method) and by 23 RFSSS BNCD causes using the Wilcoxon test.Results In 2020 vs. 2019, the mean regional SMR for cardiological causes increased by 12.07±9.86 % (from 301.02±77.67 to 336.15±84.5 %; р<0.0001). Decreases in SMR were found in 9 of 82 regions; however, only in two of them (the Republic of Ingushetia and the Sakhalin Region), SMR was decreased for all 4 groups of causes. In both 2019 and 2020 (60.9±13.8 and 62.5±12.8 %, respectively), the highest proportion of deaths was related with the 1st group of causes (chronic ischemic heart disease, IHD), with an increase in SMR of 18.66±33.28 % (р<0.0001). Increases in SMR were found in 75 regions while in the other regions, decreases in SMRs were observed. For the 2nd group of causes (myocardial infarction, other acute forms of IHD, sudden cardiac death), the mean regional SMR increased in 2020 by 3.2±18.1 % (р=0.3). Increased SMRs were noted in 54 regions. The proportion of the 2nd group in cardiological mortality was 17.3±9.7 % in 2019 and 16.1±9.6 % in 2020. The mean regional SNR for the 3rd group of causes (heart defects, myocardial diseases, etc.) increased in 2020 by 11.6±23.1 % (р=0.006). The mean regional proportion of causes for this group did not significantly changed compared to 2019 (17.5±8.2 and 17.1±7.3 %, respectively); however, the contribution of this group was greater than the contribution of the 2nd group. Increases in SMR were observed in 65 regions, while the contribution of causes related with arterial hypertension did not significantly change. Significant mid-regional differences in SMR values, dynamics of SMRs for different causes, and increases in the coefficient of variation were noted for almost all causes of death. Significant differences between 2019 and 2020 were found for 3 of 23 causes: other forms of chronic IHD (decreased SMRs in 15 regions and increased SMRs in the others), atherosclerotic heart disease (decreased SMRs in 38 regions), and alcoholic cardiomyopathy (decreased SMRs in 28 regions).Conclusion      During the COVID-19 pandemic, the SMR for cardiological causes was increased. Considerable regional differences in values and dynamics of SMR for individual causes call for attention to the unification of the criteria for clinical diagnosis.

Forecast of the socioeconomic burden of COPD in the Russian Federation in 2022

Chronic obstructive pulmonary disease (COPD) is characterized by a high level of morbidity and mortality and is associated with significant social and economic losses for the health care system and society. Aim. To predict the socio-economic burden of COPD in the Russian Federation in 2022, including the cost of drug treatment. Methods. The socio-economic burden of COPD in the Russian Federation in 2022 was predicted with and without taking into account the impact of COVID-19. The analysis of the cost of illness included the calculation of direct and indirect costs due to COPD. Data of Federal State Statistics Service, the State Guarantee Program of Free Medical Care for Citizens of Russian Federation, and data from the regional register of drug treatment of patients with COPD were used. Costs of medical care (ambulatory, hospital, and emergency care) were calculated based on compulsory health insurance tariffs. The disability benefits payments were calculated based on number of disabled persons and the amount of the disability benefit in each group. Indirect costs (or economic losses) included losses from products which were not produced due to disability and premature mortality of working-aged adults. Results. The predicted total economic losses due to COPD in 2022 will be 428.5 billion rubles when taking into account the impact of COVID-19, and 378.9 billion rubles when not accounting for COVID-19. Losses in the economy due to decreased labor productivity because of premature deaths (86%) are major part of the main burden. The cost of drug therapy for patients with COPD in outpatient settings will amount to over 17 billion rubles. Conclusion. Potential economic burden of COPD in 2022 depends on the incidence of COVID-19 and could be 0.34% of the GDP. Priority should be given to measures aimed at preventing the occurrence of COPD by correcting risk factors in the population, early diagnosis, slowing the progression of the disease and preventing exacerbations. Prevention of respiratory infections including COVID-19 in patients with COPD plays a special role.

Evolution of Approaches to Therapeutic Prevention and Treatment of the New Coronavirus Infection.

The means of drug intervention for the prevention and treatment of new coronavirus infection (COVID-19) are discussed. Changes in approaches aimed at the main links of pathogenesis and capable of positively influencing the course and outcome of the disease that have been implemented after the appearance of the results of numerous randomized trials are presented. Some aspects of the ongoing study of the problem are characterized.

Predictors of death within 6 months after non-ST elevation myocardial infarction in post-COVID-19 patients

Objective. To investigate predictors of death within six months of non-ST elevation myocardial infarction (NSTEMI) in post-COVID-19 patients. Material and methods. Outcomes were analyzed in 185 patients treated for NSTEMI at the Demikhov City Clinical Hospital from July 2020 to March 2021. Six months after discharge from the hospital, telephone interviews were conducted with treated patients, and in the absence of the possibility of personal contact, with their next of kin. During the survey, an assessment was made of the vital status (alive/dead), the presence of repeated hospitalizations and their causes. In the event of a patient's death, the cause of death was clarified on the basis of information received from relatives or from a unified medical information analytical system. Results. Overall mortality within 6 months after NSTEMI was 9.7% (n=18), in the COVID(+) group — 13.8% (n=13), in the COVID(-) group — 5.5% (n=5), p=0.0558. By causes of death, both groups are comparable (p>0.05). Median survival in patients in the COVID(+) group was 5.4 months (95% CI 5.1-5.7) and 5.9 months (95% CI 5.8-6.0) in patients in the COVID(-) group (X2=5.27;p=0.0217). The deceased and survivors were comparable in terms of gender and age (p>0.05). The deceased patients had lower baseline values of SpO2, hemoglobin, glomerular filtration rate (GFR) and had a higher score on the Syntax scale, C-re-active protein (CRP), creatinine (p<0.05). Patients had a history of COVID-19 in 72.2% (n=13) of lethal cases (p=0.0554). In 72.2% (n=13) of patients with a fatal outcome, multivessel coronary artery disease was noted (p<0.0001). With the development of NSTEMI within 28 days of COVID-19 disease, there was an increase in the risk of death (RR 33.2;p<0.0001). Predictors of the development of a lethal outcome after 6 months were an increase in the titer of IgG to SARS-CoV-2 ≥ 234.9 U/l, CRP ≥ 17.3 mg/l, a decrease in prothrombin time <9.5 s, GFR < 46.9 ml/l min/1.73 m2. Conclusion. Patients who survived COVID-19 showed a trend towards a higher incidence of deaths within 6 months. The development of a non-ST elevation myocardial infarction within 28 days of the onset of COVID-19 symptoms was accompanied by a significant increase in the chances of death within 6 months. A significant impact on the risk of death within 6 months was exerted by an increased level of C-reactive protein and IgG to SARS-CoV-2, a decrease in prothrombin time and glomerular filtration rate. © 2022, Media Sphera Publishing Group. All rights reserved.

Dynamics of regional mortality rates for men and women from diseases and external causes in Russia for the period 2016-2019 compared to 2020

The COVID-19 pandemic has led to excess mortality in the Russian Federation. This article is a continuation of the previous study. Objective. To analyze the dynamics of mortality of men and women from all and, in particular, from three groups of causes in the regions of the Russian Federation for the period 2016-2019. compared to 2020. Material and methods. The study was conducted on the basis of Rosstat data on the number of deaths in accordance with the brief nomenclature of the causes of death of Rosstat (BNCDR) and the average annual population in one-year age groups for 2016-2020. Using the program developed in the Federal State Budgetary Institution "National Medical Research Center for Therapy and Preventive Medicine" of the Ministry of Health of Russia, the standardized mortality rates (SMRs) from all causes and three groups of causes were determined according to the previously described method, and the SMRs were compared. Results. A decrease in SMR from all causes from 2016 to 2019 was observed in less than half of the regions (women in 34, men in 37 regions;in the rest, undulating dynamics was noted). In 2020, the regional average SDR from all causes compared to the 2016-2019 average increased (p<0.0001) in all regions (SMR of men by 17.3±6.3%, women — by 14.5±6.1%;in 4 regions, the increase was more than 25%). From 2016 to 2019, male deaths from diseases decreased from year to year in 30 regions;women — at 28;from causes associated with alcohol and drugs — in 19 and 21 regions, respectively;from external causes in 40 and 30 regions. The rest showed undulating dynamics. In 2020 compared to the average value of 2016-2019. the average regional value of SMR from diseases increased statistically significantly (p<0.0001) and decreased (p<0.0001) from external causes (SDR of men by 15.69±6.22% and 8.82±11.43%, respectively, and women by 16.6±6.57% and 11.3±13.69%). An increase in mortality of men and women from causes associated with alcohol and drugs was noted in 35 and 34 regions, from external causes — in 9 and 12 regions. The proportion of two groups of causes (external and associated with alcohol and drugs) in men was 14.8±3.4% (average across regions in 2016-2019) and 12.5±3.8% (2020), in women 7.8±3.3% and 6.1±2.3%, respectively. It is for these groups of reasons that the maximum differences in mortality between men and women are recorded (4 times on average). Conclusions. Until 2020, more than half of the regions of the Russian Federation showed unstable trends in standardized mortality rates. Interregional differences in standardized mortality rates from diseases are smaller than those from causes of the other two groups considered. The study established the need to study interregional differences in the mortality of men and women in order to establish the reasons for both the decrease and increase in indicators. © 2022, Media Sphera Publishing Group. All rights reserved.