[Creation of registers as one of the mechanisms for improving medical care for patients with chronic heart failure. Problem state].

The annual mortality of patients with clinically pronounced symptoms of chronic heart failure in the Russian Federation reaches 26-29%, i.e., from 880 to 986 thousand patients with heart failure die in the country in one year, which is comparable to the population of a large city. Providing care for patients with heart failure places a heavy burden on the country's health care system, making a significant contribution to mortality rates, hospitalization rates, including readmissions, which in turn requires considerable costs. The article presents an overview of registry studies that are devoted to assessing the effectiveness of diagnostics, the completeness of examinations, as well as the adequacy of ongoing drug treatment.

Protective measures of patients with cardiovascular diseases from exposure to heat waves: medicated and non-medicated.

In conditions of climate warming with an increase in heat waves associated with an increase in cardiovascular morbidity and mortality, the particular interest is the effect of cardiovascular drugs on adaptation to high temperatures. The review reflects the results of European and domestic studies on the safety of therapy during long and short heat waves. Recommendations for the correction of therapy during this period are given. Self-control of blood pressure (SCAD) is a mandatory component of the therapy of arterial hypertension during heat waves. With the development of clinically significant hypotension, a reduction in the dose of antihypertensive drugs is necessary. It is recommended to start with a dose reduction and/or withdrawal of diuretics and nitrates. Not recommended the complete abolition of antihypertensive therapy because of the risk of hypertensive crises, characteristic of abnormal heat, as well as due to the increase in blood pressure when the weather changes and the temperature drops. With increasing blood pressure during heat waves, it is recommended to give preference to calcium channel antagonists, angiotensin converting enzyme inhibitors (ACE inhibitors) and selective beta-blockers. It is necessary to inform patients about the additional protective effect of statins in order to increase adherence to therapy. Patients taking diuretics require individual daily monitoring of fluid intake and body weight. An overview of recommendations on sanogenic behavior during heat waves is given. Details are considered rules for the use of air conditioning, methods of diagnosis of dehydration and drinking mode Keywords: heat waves, cardiovascular complications, preventive measures.

[The Effectiveness of Russian Public Health Recommendations for Sanogennykh Behavior in the Heatwave].

UNLABELLED: There is an urgent need to create adapted for the Russian population of the recommendations in order to improve the efficiency and automation of the process of informing patients about the correct (sanogennykh) behavior in the heat. The proposed health WHO recommendations in 2010 year are difficult to perception, understanding and subsequent patient use without consulting a doctor. THE GOAL: creating and testing adapted for the Russian population recommendations for sanogennykh behavior during the summer heat on the basis of the recommendations of the WHO in 2010. MATERIALS AND METHODS: 155 persons older than 30 years, 93 people were adapted recommendations (group 1), 62--"classic" WHO recommendations 2010 (group 2). The groups were comparable in terms of the main clinical and demographic characteristics. Results: in the summer 2014 heat waves observed 2: 4 and 10 days, the maximum temperature of 32.7 °C. On the "deterioration of health during a heat wave", complained 20.6% of patients receiving tailored recommendations, and 40%--classic (p = 0.008). The number of cardiovascular complications in group 1 was 0.0 (0.3, 1.4) in group 2--0.0 (0.6, 2.4; p = 0.000). Most effective recommendations noted patients with coronary heart disease and hypertension (87.5%; 9 of them were adapted recommendations 4--"classic") and chronic heart failure (80%; all they got adapted recommendations). CONCLUSION: customized recommendations sanogennykh behavior during heat waves can be recommended for use in clinical practice for patients with cardiovascular diseases.

[Impact of a cold wave on disease course, hemodynamics, carbohydrate metabolism, and blood rheological properties in cardiac patents].

AIM: To study the impact of cold waves on disease course, hemodynamics, lipid and carbohydrate metabolisms, oxidative stress, and blood rheological properties in patients with cardiovascular diseases (CVD). SUBJECTS AND METHODS: 24 men and 36 women (their mean age was 62.9±9.7 years) were examined; coronary heart disease (CHD) and hypertension were present in 40 and 95% of the patients, respectively; selected therapy remained unchanged throughout the entire period. The investigators measured blood pressure and pulse wave velocity (PWV), carried out biochemical blood tests, estimated plasma oxidized low-density lipoproteins (oxLDL) and malondialdehyde (MDA) and erythrocyte superoxide dismutase (SOD) activity, calculated a MDA/SOD ratio, determined blood viscosity; as well as assessed quality of life using a visual analogue scale (VAS) and a specially developed questionnaire. RESULTS: Female sex, CHD, type 2 diabetes mellitus (DM-2) were independent predictors of cardiovascular events (CVEs) in the frost period. The persons who had experienced CVEs in frost had higher baseline PWV. CVEs, such as hypertensive crisis, emergency calls, cardiac arrhythmias, and the larger number of adverse reactions, were more commonly recorded in frost. There was an increase in blood glucose levels, a decrease in oxLDL, a rise in η2/η1, and a reduction in plasma viscosity during frost and elevated glycation end product levels at visit 2. Conclusion. The cold wave is associated with the larger number of CVEs in some patients with CVD during selected therapy. CHD, DM-2, female sex are independent predictors of CVE in patients with CVD during the winter period. In this period, there were increases in the levels of glucose, glycation end products, and erythrocyte aggregation, and a reduction in plasma viscosity.

[Using meldonium to improve the adaptation of patients with cardiovascular disease to the effects of heat and correction of associated oxidative stress].

Given that prolonged exposure to extreme climatic situations may play a role independent of stress factors, influencing the course of the underlying disease, the authors considered appropriate assessment of the effectiveness of additional prophylactic administration of drugs that increase the body's resistance to stress (adaptogens). The purpose of the study - to evaluate the effect of oxidative stress on meldonium, hemodynamics and quality of life of patients with cardiovascular disease (CVD) in extreme climatic conditions (summer heat). The study included 56 patients with CVD aged 38-75 years. Patients were randomized into two groups: active management (M), which in addition to basic therapy during 3 summer months received meldonium (500 mg/day), and control. The following parameters were measured: office blood pressure (BP), blood plasma malondialdehyde (MDA), erythrocyte superoxide dismutase (SOD) activity, level of oxidized low-density lipoprotein. MDA/SOD ratio was calculated. Visual analogue scale was used for assessment of quality of life. Meldonium treated patients demonstrated marked reduction of systolic BP and heart rate during heat, increased sodium level at the 2nd visit, improved quality of life. These changes corresponded to adaptive responses of healthy men. No significant dynamics of these parameters occurred in control group. MDA level during heat increased in both groups (p<0.05) but MDA/SOD ratio, which characterizes the "oxidation potential" of blood, increased significantly during the summer heat only in the control group. Meldonium can be used as an adaptogen in CVD patients during the summer heat.

[The ability to use meldonium as adaptogen in winter in patients with cardiovascular disease].

Given that the effects of frost can play the role of independent stress factor influencing the course of cardiovascular disease (CVD), it is reasonable to supplementation of drugs that increase the body's resistance to cold stress. Aim: To evaluate the possibility of using meldonium to prevent unwanted seasonal changes in CVD patients in the winter. The study included 49 patients with CVD aged 38-75 years. Patients were randomized into 2 groups: active management (M), in which in addition to the basic therapy received during the winter 3 months meldonium 1000 mg/day, and a control (K). We measured office blood pressure, heart rate, blood chemistry, determination of glycosylation end products (DGP). Filled with a visual analogue scale (VAS) to assess the quality of life (QOL). During frost marked increase in blood glucose (p = 0.02) in group K, persisting throughout the winter, and an increase in tissue DGP in March (p = 0.002). In group M glucose and DGP not significantly raised. In group M at the peak of cold showed a reduction in cholesterol levels. Admission meldonium associated with improved quality of life, in the dynamics of the group K was negative [Δ +10.0 VAS scores in group M versus -7.5 points in the group K in the cold (p = 0.04) and Δ +10,0 points vs -5.0 points, respectively, in March 2014 (p = 0.055)]. Adding to the basic treatment of patients with CVD meldonium in a dose of 1000 mg/day in winter, accompanied by improved quality of life, as well as let negative changes in carbohydrate metabolism.

[Impact of cardiac drug intake on adaptation to high temperatures in patients with cardiovascular diseases under conditions of the abnormally hot summer of 2010].

AIM: To evaluate the impact of intake of cardiac drugs on adaptation to abnormal heat in patients with cardiovascular diseases (CVD). SUBJECTS AND METHODS: The study covered 188 patients with CVD, who had visited the Research Dispensary Department in January 2011. General clinical examination, biochemical blood analysis, and electrocardiography were made; the hospital anxiety and depression scale, the visual analog scale, and the questionnaire specially developed for this investigation were used. The authors considered acute myocardial infarction, acute stroke, hospital admission, a medical emergency team call, temporary disability (days), hypertensive crises, and unplanned visits to a doctor as estimated outcomes (endpoints) and the number of undesirable reactions a week during the abnormal heat and from September to December 2010 as a combined endpoint. RESULTS: There were a larger number of weekly adverse reactions than usual and a reduction in quality of life (QL) during the abnormal heat. Both an increase and a reduction in the dose of cardiac drugs during the abnormal heat were associated with its worse tolerability. The use of angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers (CCB) was an independent factor associated with the smaller number of complications during the abnormal heat. That of diuretics was an independent factor that was associated with a more decrease in QL in elderly patients during the heat. The intake of angiotensin receptor blockers (ARB) or nitrates was an independent factor associated with the larger number of complications during the abnormal heat. CONCLUSION: The use of ACE inhibitors and CCB is associated with fewer complications during the abnormal heat of 2010. The intake of diuretics in patients over 65 years of age and that of ARB or nitrates was associated with worse heat tolerance.

[Multicenter trial of olmesartan. Main results].

Development and introduction into practice of medicines reducing activity of the renin-angiotensin-aldosteron system the key element of which is angiotensin II (ATII) resulted in a significant improvement of efficacy of cardiovascular diseases treatment. Angiotensin converting enzyme (ACE) inhibitors and ATII receptor blockers (BRA II) effectively reduce arterial pressure, have a nephroprotective action in patients with diabetes mellitus, inhibit development of left ventricular hypertrophy. Unlike ACE inhibitors, BRA II do not exhibit the phenomenon of ATII concentration escape, they completely depress ATII interaction with AT1-receptors while AT2-receptors keep their ability to interact with this hormone. High probability of target arterial pressure achievement in the treatment with BRA II encourage higher compliance of the patients. The review of multicenter trials performed in 2007-2010 concerns a new BRA II representative--olmesartan medoxomil (OM). The trials run in two directions: hypotensive activity of OM and vaso- and other organ-protective OM properties.