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.

[The impact of BMI on the course of the acute SARS-COV-2 infection and the risks that emerge during the first year after the hospital discharge. Subanalysis evidence of the AKTIV and AKTIV 2 registries].

BACKGROUND: There is enough evidence of the negative impact of excess weight on the formation and progression of res piratory pathology. Given the continuing SARS-CoV-2 pandemic, it is relevant to determine the relationship between body mass index (BMI) and the clinical features of the novel coronavirus infection (NCI). AIM: To study the effect of BMI on the course of the acute SARS-COV-2 infection and the post-covid period. MATERIALS AND METHODS: AKTIV and AKTIV 2 are multicenter non-interventional real-world registers. The АКТИВ registry (n=6396) includes non-overlapping outpatient and inpatient arms with 6 visits in each. The АКТИВ 2 registry (n=2968) collected  the  data  of  hospitalized  patients  and  included  3  visits.  All  subjects  were  divided  into  3  groups:  not  overweight  (n=2139), overweight (n=2931) and obese (n=2666). RESULTS: A higher BMI was significantly associated with a more severe course of the infection in the form of acute kidney injury (p=0.018), cytokine storm (p<0.001), serum C-reactive protein over 100 mg/l (p<0.001), and the need for targeted therapy (p<0.001) in the hospitalized patients. Obesity increased the odds of myocarditis by 1,84 times (95% confidence interval [CI]: 1,13-3,00) and the need for anticytokine therapy by 1,7 times (95% CI: 1,30-2,30).The  patients  with  the  1st  and  2nd  degree  obesity,  undergoing  the  inpatient  treatment,  tended  to  have  a  higher  probability  of  a  mortality  rate.  While  in  case  of  morbid  obesity  patients  this  tendency  is  the  most  significant  (odds  ratio  -  1,78; 95% CI: 1,13-2,70). At the same time, the patients whose chronical diseases first appeared after the convalescence period, and those who had certain complaints missing before SARS-CoV-2 infection, more often had BMI of more than 30 kg/m2 (p<0,001).Additionally, the odds of death increased by 2,23 times (95% CI: 1,05-4,72) within 3 months after recovery in obese people over the age of 60 yearsCONCLUSION.  Overweight  and/or  obesity  is  a  significant  risk  factor  for severe  course  of  the  new  coronavirus  infection  and  the associated cardiovascular and kidney damage Overweight people and patients with the 1st and 2nd degree obesity tend to have a high risk of death of SARS-CoV-2 infection in both acute and post-covid periods. On top of that, in case of morbid obesity patients this tendency is statistically significant. Normalization of body weight is a strategic objective of modern medicine and can contribute to prevention of respiratory conditions, severe course and complications of the new coronavirus infection.

FEATURES OF DAMAGE TO VITAL ORGANS DUE TO SARS-CoV-2 INFECTION

SARS-CoV-2 infection continues to be relevant for healthcare systems because it is widespread and characterized by systemic lesions. Complications of the disease primarily affect the respiratory, cardiovascular and urinary systems. In severe cases, secondary infection may join and acute distress syndrome may develop. The most formidable complication, with a high frequency leading to the death of patients, is multiple organ failure. Undoubtedly, the presence of concomitant pathology in the patient has a negative impact on the course of COVID-19 and affects the prognosis of the disease, which requires special attention in clinical practice for their detection and rapid response in order to optimize therapy. The spectrum of complications is very wide. From the cardiovascular system, these are myocarditis, acute myocardial infarction, thromboembolic events. Acute kidney injury and/or worsening of the course of chronic kidney disease also often develops. This review examines several issues related to the defeat of vital organs, various clinical variants of the course of the disease. Particular attention is paid to the damage of the kidneys and cardiovascular system, as the most vulnerable systems for the SARS-CoV-2 virus. © Ю.В. Лаврищева, А.О. Конради, А.А. Яковенко, 2022.

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.

Prediction of fatal outcome in patients with confirm COVID-19

SARS-CoV-2, the new coronavirus underlying the development of the COVID-19 pandemic, has led to a sharp increase in the burden on healthcare systems, high mortality and significant difficulties in organizing medical care. The aim of the study was to conduct a systematic analysis of factors affecting the course of infectious disease in patients with diagnosed COVID-19 hospitalized. In order to predict the course of the disease and determine the indications for more aggressive treatment, many different clinical and biological markers have been proposed, however, clinical and laboratory assessment of the condition is not always simple and can clearly predict the development of a severe course. Technologies based on artificial intelligence (AI) have played a significant role in predicting the development of the disease. One of the main requirements during a pandemic is an accurate prediction of the required resources and likely outcomes. In the present study, a machine learning (ML) approach is proposed to predict the fatal outcome in patients with an established diagnosis of COVID-19 based on the patient’s medical history and clinical, laboratory and instrumental data obtained in the first 72 hours of the patient’s stay in the hospital. A machine learning algorithm for predicting the lethal outcome in patients with COVID-19 during 72 hours of hospitalization demonstrated high sensitivity (0.816) and specificity (0.865). Given the serious concerns about limited resources, including ventilators, during the COVID-19 pandemic, accurately predicting patients who are likely to require artificial ventilation can help provide important recommendations regarding patient triage and resource allocation among hospitalized patients. In addition, early detection of such persons may allow for routine ventilation procedures, reducing some of the known risks associated with emergency intubation. Thus, this algorithm can help improve patient care, reduce patient mortality and minimize the burden on doctors during the COVID-19 pandemic. © 2022, ITMO University. All rights reserved.

COVID-19 Pandemic and Cardiovascular Diseases: Lessons and Prospects.

This article is focused on the topicality of assessing complications and mortality from diseases of the circulatory system during the COVID-19 pandemic. The main variants of damage to the cardiovascular system, the mechanisms of their development, and risk factors are given. The long-term consequences of the new coronavirus infection for the heart and blood vessels are considered. In addition, the necessary measures to reduce the burden of disease after the pandemic are discussed.

Hypertension control during the COVID-19 pandemic: results of the MMM2021 in Russia

Repetitive quarantines and social restrictions during the coronavirus disease 2019 (COVID-19) pandemic have negatively affected the population health in general, and the control of hypertension (HTN) in particular. Aim. To evaluate the control of HTN in the Russian population during the COVID-19 period based on the results of screening for HTN May Measurement Month 2021 (MMM2021). Material and methods. During May-August 2021, 2491 participants from 11 Russian regions took part in the screening. Participation was voluntary without restrictions on sex. All participants were over 18 years of age. During the screening, blood pressure (BP) was measured three times using automatic and mechanical BP monitors. In addition, a questionnaire was filled out on behavioral risk factors, comorbidities and therapy. HTN was diagnosed with systolic BP ≥140 mmHg and/ or diastolic blood pressure ≥90 mmHg and/or taking antihypertensive therapy. The questionnaire included questions about prior COVID-19, vaccinations and their impact on the intake of antihypertensive drugs. Results. The analysis included data from 2461 respondents aged 18 to 92, of which 963 were men (39,1%). The proportion of hypertensive patients was 41,0%, while among them 59,0% took antihypertensives and 30,9% were effectively treated. In comparison with pre-pandemic period according to MMM2018-2019, the higher proportion of HTN patients in the Russian sample was revealed during MMM2021 (41,0% vs 31,3%, p<0,001) with a comparable proportion of patients receiving antihypertensive therapy (60,7% vs 59,0%, p=0,05) and treatment efficacy (28,7% vs 30,9%, p=0,36). Monotherapy was received in 44,7% of cases, while dual and triple combination therapy — in 30,9% and 14,1%, respectively. The majority of respondents (~90%) did not adjust their antihypertensive therapy during the COVID-19 pandemic. Conclusion. According to HTN screening in Russia, there is persistent ineffective control of HTN, which may be due to both the worsening pattern of behavioral risk factors, limited access to healthcare during COVID-19, and the inertia of physicians and low adherence of patients due to the asymptomatic HTN course in the majority.

Comparative analysis of echocardiographic and electrocardiographic data of survivors and deceased patients with COVID-19 (sub-analysis of the international register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors”)

Aim. To carry out comparative analysis of echocardiographic and electrocardiographic (ECG) data of survivors and deceased patients with COVID-19 (sub-analysis of the international register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors”). Material and methods. The study presents the results of a sub-analysis of the international AKTIV registry, which was called AKTIV CARDIO. Data were collected from 9 medical centers in the Russian Federation. AKTIV CARDIO included 973 hospitalized patients, of which 50 patients died during hospitalization. Results. Comparative analysis of echocardiographic parameters revealed that 4 parameters differed in deceased patients compared to survivors: left ventricular ejection fraction (LVEF), right ventricular end diastolic dimension (RV EDD), right atrial (RA) short axis diameter and pulmonary artery systolic pressure (PASP). RA short axis diameter was higher in deceased patients compared with survivors (38,0 [36,0;39,0] versus 35,0 [33,0;38,0] mm, p=0,011). RV EDD was higher in deceased patients than in survivors (3,0 [29,0;33,0] vs 28,0 [27,0;32,0] mm, p=0,019). LVEF was lower in deceased patients compared with survivors (55 [52;55] vs 60 [56;65]%, p<0,001). PASP was higher in deceased patients compared with survivors (25 [21;35] vs 20 [19;25] mm Hg, p=0,006). Correlation analysis found that the largest number of correlations with markers of the infection severity was observed for RA short axis diameter and RV EDD. A comparative analysis of ECG data revealed that in deceased patients, compared with survivors, atrial fibrillation (AF) (21,4% vs 6,06%, p=0,001) and supraventricular premature beats (14,3% vs 3,36%, р=0,004) occurred more often. In addition, deceased patients had longer QTc interval (440 [416;450] vs 400 [380;430] ms, p<0,001). Conclusion. Comparative analysis of echocardiographic data showed that deceased patients have more pronounced right heart remodeling, higher PASP and lower LVEF. Patient survival was related to RV and RA sizes. Right heart enlargement was associated with markers of infection severity. Echocardiographic parameters characterizing the right heart side can probably be independent prognostic factors in the acute COVID-19 period.

[ACTIV SARS-CoV-2 registry (Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients). Assessment of impact of combined original comorbid diseases in patients with COVID-19 on the prognosis].

AIM: Study the impact of various combinations of comorbid original diseases in patients infected with COVID-19 later on the disease progression and outcomes of the new coronavirus infection. MATERIALS AND METHODS: The ACTIV registry was created on the Eurasian Association of Therapists initiative. 5,808 patients have been included in the registry: men and women with COVID-19 treated at hospital or at home. CLINICALTRIALS: gov ID NCT04492384. RESULTS: Most patients with COVID-19 have original comorbid diseases (oCDs). Polymorbidity assessed by way of simple counting of oCDs is an independent factor in negative outcomes of COVID-19. Search for most frequent combinations of 2, 3 and 4 oCDs has revealed absolute domination of cardiovascular diseases (all possible variants). The most unfavorable combination of 2 oCDs includes atrial hypertension (AH) and chronic heart failure (CHF). The most unfavorable combination of 3 oCDs includes AH, coronary heart disease (CHD) and CHF; the worst combination of 4 oCDs includes AH, CHD, CHF and diabetes mellitus. Such combinations increased the risk of lethal outcomes 3.963, 4.082 and 4.215 times respectively. CONCLUSION: Polymorbidity determined by way of simple counting of diseases may be estimated as a factor in the lethal outcome risk in the acute phase of COVID-19 in real practice. Most frequent combinations of 2, 3 and 4 diseases in patients with COVID-19 primarily include cardiovascular diseases (AH, CHD and CHF), diabetes mellitus and obesity. Combinations of such diseases increase the COVID-19 lethal outcome risk.

Analysis of influence of background therapy for comorbidities in the period before infection on the risk of the lethal COVID outcome. Data from the international ACTIV SARS-CoV-2 registry («Analysis of chronic non-infectious diseases dynamics after COVID-19 infection in adult patients SARS-CoV-2¼).

Aim      To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods  The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients' privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 visits, 3 in-person visits during the acute period and 3 virtual visits (telephone calls) at 3, 6, and 12 mos. Patient enrollment started on June 29, 2020 and was completed on October 29, 2020. The registry completion is scheduled for October 29, 2022. The registry ID: ClinicalTrials.gov: NCT04492384. In this fragment of the study of registry data, the work group analyzed the effect of therapy for comorbidities at baseline on severity and outcomes of the novel coronavirus infection. The study population included only the patients who took their medicines on a regular basis while the comparison population consisted of noncompliant patients (irregular drug intake or not taking drugs at all despite indications for the treatment).Results The analysis of the ACTIVE registry database included 5808 patients. The vast majority of patients with COVID-19 had comorbidities with prevalence of cardiovascular diseases. Medicines used for the treatment of COVID-19 comorbidities influenced the course of the infectious disease in different ways. A lower risk of fatal outcome was associated with the statin treatment in patients with ischemic heart disease (IHD); with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists and with beta-blockers in patients with IHD, arterial hypertension, chronic heart failure (CHF), and atrial fibrillation; with oral anticoagulants (OAC), primarily direct OAC, clopidogrel/prasugrel/ticagrelor in patients with IHD; with oral antihyperglycemic therapy in patients with type 2 diabetes mellitus (DM); and with long-acting insulins in patients with type 1 DM. A higher risk of fatal outcome was associated with the spironolactone treatment in patients with CHF and with inhaled corticosteroids (iCS) in patients with chronic obstructive pulmonary disease (COPD).Conclusion      In the epoch of COVID-19 pandemic, a lower risk of severe course of the coronavirus infection was observed for patients with chronic noninfectious comorbidities highly compliant with the base treatment of the comorbidity.

International register “dynamics analysis of comorbidities in sars-cov-2 survivors” (Aktiv sars-cov-2): Analysis of predictors of short-term adverse outcomes in covid-19

The international AKTIV register presents a detailed description of out-and inpatients with COVID-19 in the Eurasian region. It was found that hospitalized patients had more comorbidities. In addition, these patients were older and there were more men than among outpatients. Among the traditional risk factors, obesity and hypertension had a significant negative effect on prognosis, which was more significant for patients 60 years of age and older. Among comorbidities, CVDs had the maximum negative effect on prognosis, and this effect was more significant for patients 60 years of age and older. Among other comorbidities, type 2 and 1 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cancer and anemia had a negative impact on the prognosis. This effect was also more significant (with the exception of type 1 diabetes) for patients 60 years and older. The death risk in patients with COVID-19 depended on the severity and type of multimorbidity. Clusters of diseases typical for deceased patients were identified and their impact on prognosis was determined. The most unfavorable was a cluster of 4 diseases, including hypertension, coronary artery disease, heart failure, and diabetes mellitus. The data obtained should be taken into account when planning measures for prevention (vaccination priority groups), treatment and rehabilitation of COVID-19 survivors.

International register “dynamics analysis of comorbidities in sars-cov-2 survivors” (Aktiv) and the register “analysis of hospitalizations of comorbid patients infected during the second wave of sars-cov-2 outbreak” (aktiv 2)

The organizer of the registers “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV) and “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2) is the Eurasian Association of Therapists (EAT). Currently, there are no clinical registries in the Eurasian region designed to collect and analyze information on long-term outcomes of COVID-19 survivors with comorbid conditions. The aim of the register is to assess the impact of a novel coronavirus infection on long-term course of chronic non-communicable diseases 3, 6, 12 months after recovery, as well as to obtain information on the effect of comorbidity on the severity of COVID-19. Analysis of hospitalized patients of a possible second wave is planned for register “AKTIV 2”. To achieve this goal, the register will include men and women over 18 years of age diagnosed with COVID-19 who are treated in a hospital or in outpatient basis. The register includes 25 centers in 5 federal districts of the Russian Federation, centers in the Republic of Armenia, the Republic of Kazakhstan, the Republic of Kyrgyzstan, the Republic of Belarus, the Republic of Moldova, and the Republic of Uzbekistan. The estimated capacity of the register is 5400 patients.

An open-label multicenter observational study (Registry) of patients recovered from coronavirus disease 2019 (covid-19) with involvement of the cardiovascular system or with baseline severe cardiovascular diseases: Rationale, design, and implications for clinical practice

The potential impact on cardiovascular morbidity and mortality have become one of the most important issues of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 may be associated with more frequent development of acute cardiovascular complications, while patients with established cardiovascular diseases are characterized by a higher risk of severe infection and adverse in-hospital outcomes. Due to the spread scale of the pandemic, understanding the long-term cardiovascular consequences of COVID-19 is of no less importance. Inability to extrapolate available international data to the Russian population has led to the initiation of a national multicenter study (registry) of patients recovered from COVID-19 and with concomitant involvement of the cardiovascular system or with baseline severe cardiovascular diseases. The article presents its rationale, design and implications of the results for clinical practice.

INTERNATIONAL REGISTER “DYNAMICS ANALYSIS OF COMORBIDITIES IN SARS-COV-2 SURVIVORS” (AKTIV SARS-COV-2): ANALYSIS OF 1,000 PATIENTS

COVID-19 is a severe infection with high mortality. The concept of the disease has been shaped to a greater extent on the basis of large registers from the USA, Spain, Italy, and China. However, there is no information on the disease characteristics in Caucasian patients. Therefore, we created an international register with the estimated capacity of 5,000 patients - Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (AKTIV SARS-CoV-2), which brought together professionals from the Russian Federation, Republic of Armenia, Republic of Kazakhstan, and Kyrgyz Republic. The article presents the first analysis of the register involving 1,003 patients. It was shown that the most significant difference of the Caucasian population was the higher effect of multimorbidity on the mortality risk vs other registers. More pronounced effect on mortality of such diseases as diabetes, obesity, hypertension, chronic kidney disease, and age over 60 years was also revealed. COVID-19 - тяжелое инфекционное заболевание с высоким риском летального исхода. Представление о болезни во многом сформировано на основании крупных регистров, выполненных в США, Испании, Италии, КНР. Однако к настоящему времени нет данных по особенностям протекания болезни у пациентов евроазиатского региона. В связи с этим был создан международный регистр, расчетная мощность которого составляет 5000 пациентов, “Анализ динамики Коморбидных заболеваний у пациенТов, перенесшИх инфицироВание SARS-CoV-2” (AКТИВ SARS-CoV-2), работа в котором объединила специалистов Российской Федерации, Республики Армения, Республики Казахстан и Кыргызской Республики. В статье представлен первый анализ регистра, который включил данные 1003 пациентов. Показано, что самым значимым отличием евроазиатской популяции пациентов оказалось гораздо большее влияние полиморбидности на риск летального исхода в сравнении с другими регистрами, а также более выраженное влияние на риск летального исхода в евроазиатской популяции таких заболеваний, как сахарный диабет, ожирение, артериальная гипертензия, хроническая болезнь почек и возраста старше 60 лет.

[International register "Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients (ACTIV SARS-CoV-2)"]

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[Use of Statins, Anticoagulants, Antiaggregants and Antiarrhythmic Drugs in Patients With COVID-19. The Agreed Experts' Position of Russian Society of Cardiology, Eurasian Association of Therapists, National Society on Atherothrombosis, Societies of Experts in Urgent Cardiology, Eurasian Arrhythmology Association].

This article discusses relevant aspects in the treatment of patients with COVID-19. Up-to-date information about principles for administration of statins, antithrombotics, and antiarrhythmics is presented. The authors addressed in detail specific features of reversing heart rhythm disorders in patients with coronavirus infection and the interaction of antiarrhythmic and antiviral drugs. Recommendations are provided for outpatient and inpatient antithrombotic therapy for patients with COVID-19. Issues of antithrombotic and antiviral drug interaction are discussed.

COVID-19: what are the risks for patients with sleep disorders?

Coronavirus pandemic significantly changed our lives, leading to long-lasting medical, social, economic, psychological consequences. Currently, when the COVID-19 morbidity growth is less galloping, the more important are the issues of long-lasting prognosis, rehabilitation, immunity stability, risk of recurrent infection etc. An increased incidence of stress-induced somatic and mental diseases is envisaged. Among them, sleep disorders appear to be significant and can result from various reasons: change in habitual life style, work regimen, decrease in physical activity during self-isolation, lesser daylight exposure and greater exposure to artificial light (including screens of electronic devices). The evidence confirms an important role of sleep in human health and wellbeing. The paper summarizes data on the role of sleep in immune system regulation. We pay special attention to sleep-disordered breathing which is associated with the higher risk of infection by SARS-CoV-2 and more severe COVID-19. Other sleep disorders, including changes in sleep quality and duration during the pandemic, are also discussed. The paper reviews the existing approaches to manage stress-induced sleep disorders which are applicable in the pandemic and can be implemented in rehabilitation procedures. © 2020 All-Russian Public Organization Antihypertensive League. All rights reserved.

Angiotensin II and COVID-19. Secrets of interactions

The article describes current data on the relationship of renin-angiotensin system and related drugs with the risk of COVID-19 infection and its outcomes. Analysis of the latest publications did not reveal association of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with any risk of an unfavorable out-comes, and there was no data for withdrawal of these drugs.