[Atrial fibrillation in old age: risk management and features of the use of direct oral anticoagulants].

Senile patients with atrial fibrillation (AF) are at a higher risk of thromboembolism and hemorrhage than younger patients. Three direct oral anticoagulants (DOAC), apixaban, dabigatran, and rivaroxaban, are registered in the Russian Federation and are extensively used for prevention of stroke in patients with AF. The DOAC treatment of older patients requires considering peculiarities of these patients, clinical situation and properties of individual drugs to achieve the balance of efficiency and safety and a comprehensive protection. According to studies of real clinical practice DOAC may have advantages over warfarin (reduced risk of fractures, diabetes mellitus, and dementia). Compliance with and constancy of the DOAC treatment are important for its efficiency, particularly in senile age. Results of clinical trials and real clinical practice studies have confirmed that rivaroxaban may provide a comprehensive protection for a senile patient with AF due to favorable indexes of efficiency and safety, beneficial effect on the risk of coronary events and impairment оf renal function, whereas once a day dosing of rivaroxaban improves the compliance with this treatment and its constancy.

[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.

[Combined Antithrombotic Therapy in Patients with a Stable Atherosclerotic Cardiovascular Diseases: What Direction did COMPASS Show?]

In patients with stable ischemic heart disease (IHD) and/or peripheral artery disease (PAD), current secondary prevention, including the antiplatelet monotherapy, is associated with a significant residual risk of recurrent cardiovascular complications (CVC). Practical application of results from many modern studies evaluating the effect of secondary prevention of atherothrombosis is complicated. An additional influence on coagulation may play a key role in prevention of atherothrombosis. In the COMPASS study, adding rivaroxaban 2.5 mg, b.i.d., to the acetylsalicylic acid (ASA) monotherapy significantly reduced the risk of death from cardiovascular complications, myocardial infarction or stroke, or all-cause death compared to the ASA monotherapy, in patients with IHD or PAD. The combination antithrombotic therapy was associated with an increased risk of major, but not fatal, or intracranial bleeding. In addition, PAD patients had a reduced risk of severe ischemic lower limb complications, including amputations. According to the subgroup analysis in the COMPASS study, supplementing ASA with rivaroxaban 2.5 mg, b.i.d., may appear most beneficial for patients with stable atherosclerotic disease and with a high risk of severe CVC without causing an increased risk of bleeding.

[How to maintain an adherence to oral anticoagulant in a patient with atrial fibrillation?]

Less onerous, compared with warfarin, treatment with direct oral anticoagulants (DOA) can lead to better adherence to treatment of patients with atrial fibrillation (AF). However, in a certain number of patients with AF, who were recommended by DOA, cardioembolic stroke recurs, which is largely due to the patients' failure to comply with medical recommendations. The appointment of DOA as first-line drugs does not guarantee a high adherence of patients with non-valvular AF. For elderly and old patients with AF and numerous comorbidities, the proposal of a simpler pharmacotherapy regimen is especially important. In a number of large modern studies performed in clinical practice, high adherence to rivaroxaban therapy has been established, which may be a result of taking this DOA 1 time per day, its safety and effectiveness.

[Treatment of Patients with Stable Manifestations of Atherosclerotic Vascular Disease: New Possibilities (Conclusion of the Council of Experts from November 16, 2018, Rostov-on-Don)].

In the conclusion of the council of experts (list of participants see text) the following issues are discussed: regional specifics of diagnostics and therapy of patients with ischemic heart disease (IHD) and / or peripheral arterial disease (PAD), methods of risk assessment in patients with stable course of atherosclerotic disease, pathogenetic validity of simultaneous inhibition of coagulation and platelet thrombus formation, as well as clinical significance of a novel therapeutic approach - combined use of rivaroxaban and acetylsalicylic acid (ASA). Possible problems and ways to their solution at implementation in clinical practice of the novel scheme of antithrombotic therapy are presented. Importance of multidisciplinary approach to management of patients with IHD and concomitant diseases is stressed. Experts have noted that after registration of the corresponding indication therapy with rivaroxaban 2.5 mg twice daily and ASA 75-100 mg once daily might be recommended to majority of patients with atherosclerotic involvement of blood vessels. In real clinical practice prescription of this therapy is appropriate first of all in patients with IHD and high risk of complications - with multifocal atherosclerosis, with history of myocardial infarction after stoppage of dual antiplatelet therapy, - patients with concomitant diabetes, heart failure, and other prognosis worsening comorbid diseases. Experts express hope that in the nearest time combined antithrombotic therapy will be included into corresponding national clinical recommendations.

Congress of the European Society of Cardiology (Barcelona, 2017): Results of the Most Important Clinical Trials.

A report was presented on all four Hot Line: Late-Breaking Clinical Trials sessions of the European Society of Cardiology Congress 2017 on the results of new clinical research in cardiology.

[Triple antianginal combinations in the treatment of elderly and senile patients with stable angina]. / Trekhkomponentnye kombinatsii antianginal'nykh preparatov v lechenii bol'nykh pozhilogo i starcheskogo vozrasta so stabil'noi stenokardiei napryazheniya.

AIM: To compare the efficiency and safety of antianginal therapy (AAT) using a combination of bisoprolol, ivabradine, and trimetazidine or ranolazine in elderly and senile patients with stable angina. SUBJECTS AND METHODS: The study enrolled 107 patients aged 60 to 79 years with coronary heart disease and Functional Class II and III angina. When the patients taking bisoprolol 1.25-2.5 mg once daily and ivabradine 2.5-7.5 mg twice daily continued to have angina and/or silent myocardial ischemia, after randomization 54 patients received an additional 35 mg of trimetazidine twice a day and 53 patients had ranolazine 500 mg twice daily. A comprehensive clinical and instrumental study was conducted prior to randomization and after 6 months of triple AAT. RESULTS: The patients tolerated well both treatments that substantially improved the results of a treadmill exercise test. Trimetazidine reduced to a greater extent the duration of silent ST-segment depression, as evidenced by Holter monitoring. Trimetazidine and ranolazine comparably improved left ventricular systolic and diastolic function, large arterial structure and function, and quality of life in the patients. CONCLUSION: The combinations of the low-dose ß-blocker with ivabradine and trimetazidine or ranolazine may be used to treat refractory stable angina in elderly and senile patients. Trimetazidine is preferred due to its higher efficacy in treating silent myocardial ischemia and to its lower cost.

[Comparison of Verapamil and Amlodipine for Treatment of Chronic Heart Failure With Preserved Left Ventricular Ejection Fraction in Patients With Hypertensive Disease].

OBJECTIVE: to compare efficacy of verapamil and amlodipine in treatment of chronic heart failure (CHF) with preserved left ventricular (LV) ejection fraction (EF) in patients with hypertensive disease (HD). MATERIAL AND METHODS: Patients with stage III HD, class II-III CHF, and LVEF more or equal 50% (n=167, age 48-70 years) underwent complex examination before and after 12 months of treatment with perindopril combined either with verapamil SR (n=85) or amlodipine (n=82). RESULTS: Average 6-minute walk distance increased after both verapamil and amlodipine containing treatment (by 15.1 and 18.2%, respectively). Administration of both drugs was associated with improvement of clinical state and quality of life. But only treatment containing amlodipine was associated with lowering of N-terminal probrain natriuretic peptide and improvement of echocardiographic parameters of LV diastolic function. CONCLUSION: In treatment of CHF in patients with HD amlodipine is at least not inferior to verapamil for elevation of exercise tolerance and superior to verapamil for improvement of LV diastolic function. Amlodipine might be perspective for use in patients with chronotropic incompetence.

[Treatment of Patients With Atrial Fibrillation: the Search for Optimal Solutions].

Atrial fibrillation (AF) - the most common arrhythmia in clinical practice, impair the quality of life significantly increases morbidity and mortality. Current methods of treatment of patients with AF, except anticoagulant therapy hitherto failed to provide significant improvement in cardiovascular events are of limited effectiveness and cause significant side effects. The article presents the current opportunities and challenges for the treatment of patients with atrial fibrillation. Analysis of these data will allow for an informed choice of treatment facilities for individual patients. Appreciates the role of oral anticoagulants and the occluder appendage of the left atrium in the prevention of thromboembolic complications. We consider the current possibilities of improving the efficiency and tolerability of pharmacotherapy AF antiarrhythmics. We discuss the latest achievements of non-pharmacological treatment of AF, including catheter ablation in the left atrium and change the patients lifestyle.

[Congress of the European Society of Cardiology (Barcelona, 2014): Results of Most Important Clinical Studies].

This brief report on the European Society of Cardiology Congress 2014 contains detailed reflection of results of international studies presented at 5 Hot Line scientific sessions.

[ADVANCE-ON Trial; How to Achieve Maximum Reduction of Mortality in Patients With Type 2 Diabetes].

Of 10,261 patients with type 2 diabetes who survived to the end of a randomized ADVANCE trial 83% were included in the ADVANCE-ON project for observation for 6 years. The difference in the level of blood pressure which had been achieved during 4.5 years of within trial treatment with fixed perindopril/indapamide combination quickly vanished but significant decrease of total and cardiovascular mortality in the group of patients treated with this combination for 4.5 years was sustained during 6 years of post-trial follow-up. The results can be related to gradually weakening protective effect of perindopril/indapamide combination on cardiovascular system, and are indicative of the expedience of long-term use of this antihypertensive therapy for maximal lowering of mortality of patients with diabetes.

[Heart Rate and Cardioprotection: New Data and Perspectives].

The article presents the results of new experimental and clinical studies of selective inhibitor of If-channel, ivabradine confirming the feasibility of its use in coronary heart disease and chronic heart failure. We discuss some of the pleiotropic effects of ivabradine. Ivabradine may be useful in therapeutic areas outside those where it has previously demonstrated clinical efficacy.

[Congress of European society of cardiology (amsterdam, 2013): new recommendations and most important clinical studies].

In this review we present short report on European Congress of Cardiology which took place in Amsterdam from August 3 to September 4, 2013. Four new European recommendations on the treatment of cardiovascular diseases are briefly characterized and reports of Hot Line and Clinical Trial Update scientific sessions are presented.

[Antiarrhythmic therapy in patients with paroxysmal and persistent atrial fibrillation: identification of achievable goals and assessment of available funds].

One of the achievable goals of treatment of patients with paroxysmal and persistent atrial fibrillation should be to prevent the progression to permanent form of arrhythmia, which is associated with an increased risk of complications and worsening prognosis. The review presents easily identifiable predictors of progression of atrial fibrillation, reviews the available treatment options and their effectiveness and safety.

[ATLANTIC trial and feasibility of early administration of ticagrelor in myocardial infarction].

The ATLANTIC trial compared effects of initiation of ticagrelor at the prehospital (ambulance) or hospital (in the catheterization laboratory) stage of treatment of patients with ST-segment elevation myocardial infarction. Initiation of therapy with ticagrelor at prehospital stage short before percutaneous coronary intervention was safe, but did not improve coronary reperfusion before this procedure. However, earlier administration of ticagrelor significantly reduced the risk of stent thrombosis after percutaneous coronary intervention.

[Results of large clinical studies presented at the European Society of Cardiology Congress 2012].

The article contains short characteristics of 6 novel European guidelines on the treatment of cardiovascular diseases and accounts of main scientific sessions (Hot Line, Clinical Trial and Registry Update) of the European Society of Cardiology Congress 2012.

[Blockers of renin-angiotensin-aldosterone system in the treatment of arterial hypertension: classics versus the modern].

According to results of large clinical studies angiotensin II receptor blockers (ARB) and aliskiren do not lower risk of cardiovascular complications and mortality in wide spectrum of clinical conditions and are able to worsen renal outcomes. It is expedient to prefer inhibitors of angiotensin converting enzyme in particular perindopril over ARB in the treatment of patients with arterial hypertension taking into consideration differences in effect on mortality. Fixed perindopril/indapamide combination provides achievement of target arterial pressure in many patients with uncontrolled hypertension, has good tolerability, is metabolically neutral, and possesses high organoprotective properties.

[Anticoagulants in the prevention of complications in patients with atrial fibrillation].

This review presents new data on the comparative effectiveness and safety of treatment with oral anticoagulants warfarin, dabigatran, rivaroxaban, apixaban for prevention of thromboembolism in patients with atrial fibrillation.