Female and Male Phenotypes of Iron Deficiency in CHF. Additional analysis of the «The Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (J-CHF-RF)¼ study.

Aim    To evaluate the incidence of iron deficiency (ID) in men and women with chronic heart failure (CHF) and to compare clinical and functional indexes in patient with and without ID depending on the gender.Material and methods    An additional analysis of the study "Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (ID-CHF-RF)" was performed. The study included 498 (198 women, 300 men) patients with CHF, in whom, in addition to iron metabolism, the quality of life and exercise tolerance (ET) were studied. 97 % of patients were enrolled during their stay in a hospital. ID was defined in consistency with the European Society of Cardiology (ESC) Guidelines. Also, and additional analysis was performed according to ID criteria validated by the morphological picture of the bone marrow.Results    ID was detected in 174 (87.9 %) women and 239 (79.8 %) men (p=0.028) according to the ESC criteria, and in 154 (77.8 %) women and 217 (72.3 %) men (p=0.208) according to the criteria validated by the morphological picture of the bone marrow. Men with ID were older and had more severe CHF. They more frequently had HF functional class (FC) III and IV (63.4 % vs. 43.3 % in men without ID); higher concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and lower ET. HF FC III increased the probability of ID presence 3.4 times (p=0.02) and the probability of HF FC IV 13.7 times (p=0.003). This clinical picture was characteristic of men when either method of determining ID was used. In women, ID was not associated with more severe CHF.Conclusion    Based on the presented analysis, it is possible to characterize the male and female ID phenotypes. The male ID phenotype is associated with more severe CHF, low ET, and poor quality of life. In females of the study cohort, ID was not associated with either the severity of CHF or with ET.

[Prospects for use of Vericiguat in HFrEF: Implications of VICTORIA Trial Results. Advisory Board Summary].

In September 2021, an online meeting of the Council of Experts was held. The proposed focus of discussion was publishing the results of an international prospective, randomized, double-blind, placebo-controlled study VICTORIA. The objective of the VICTORIA study was evaluation of the efficacy and safety of supplementing a standard therapy with vericiguat at a target dose of 10 mg twice a day as compared to placebo for prevention of cardiovascular death and hospitalization for heart failure (HF) in patients with clinical manifestations of chronic HF and left ventricular ejection fraction <45% who have recently had an episode of decompensated HF. The aim of the meeting was interpretation of the VICTORIA study results on efficacy and safety of vericiguat for a potential use in a Russian population of patients after a recent episode of decompensated chronic HF with reduced ejection fraction.

[Iron deficiency in Russia heart failure patients. Observational cross-sectional multicenter study].

Aim    To evaluate the prevalence of iron deficiency (ID) in Russian patients with heart failure (HF).Material and methods    Iron metabolism variables were studied in 498 (198 women, 300 men) patients with HF. Data were evaluated at admission for HF (97 %) or during an outpatient visit (3 %). ID was determined according to the European Society of Cardiology Guidelines.Results    83.1 % of patients had ID; only 43.5 % of patients with ID had anemia. Patients with ID were older: 70.0 [63.0;79.0] vs. 66.0 years [57.0;75.2] (p=0.009). The number of patients with ID increased in parallel with the increase in HF functional class (FC). Among patients with ID, fewer people were past or current alcohol users (p=0.002), and a greater number of patients had atrial fibrillation (60.1 vs. 45.2 %, p=0.016). A multiple logistic regression showed that more severe HF (HF FC) was associated with a higher incidence of ID detection, whereas past alcohol use was associated with less pronounced ID. An increase in N-terminal pro-brain natriuretic peptide (NT-proBNP) by 100 pg/ml was associated with an increased likelihood of ID (odds ratio, 1.006, 95 % confidence interval: 1.002-1.011, p=0.0152).Conclusion    The incidence rate of HF patients is high in the Russian Federation (83.1 %). Only 43.5 % of these patients had anemia. The prevalence of ID in the study population increased with increases in HF FC and NT-proBNP.

Epidemiology of atrial fibrillation in a representative sample of the European part of the Russian Federation. Analysis of EPOCH-CHF study.

Aim    To study true prevalence of atrial fibrillation (AF) in a representative sample from the European part of the Russian Federation; to describe characteristics of patients with AF; and to provide the frequency of anticoagulant treatment.Material and methods    Cross-sectional data of the EPOCH epidemiological study (2017) were used. Data were collected in 8 constituent entities of the Russian Federation; the sample size was 11 453 people. The sample included all respondents who had given their consent for participation and were older than 10 years. Statistical tests were performed in the R system for statistical data analysis.Results    The prevalence of AF in the representative sample from the European part of the Russian Federation was 2.04 %. The AF prevalence increased with age and reached a maximum value of 9.6% in the age group of 80 to 89 years. The AF prevalence among females was 1.5 times higher than among men. With age standardization, the AF prevalence was 18.95 and 21.33 per 1,000 people for men and women, respectively. The AF prevalence increased in the presence of concurrent cardiovascular diseases (CVDs) or diabetes mellitus as well as with an increased number of comorbidities in the same person and reached 70.3 and 60.0 % in patients with 4 and 5 comorbidities, respectively. Patients with AF had a greater number of comorbidities and higher CHA2DS2VASc scores (5.0 vs. 2.0, p<0.001) compared to patients with CVDs without AF. Only 22.6 % of patients with CVD and AF took anticoagulants. Only 23.9% of patients with absolute indications for the anticoagulant treatment received anticoagulants.Conclusion    The AF prevalence in the European part of the Russian Federation was 2.04 %; it increased with age and in patients with concurrent CVDs or diabetes mellitus. Most of AF patients (93.2 %) required a mandatory treatment with oral anticoagulants.

Outpatient register of patients who have suffered a myocardial infarction (REGATA): prospective follow-up data and outcomes.

Aim      To determine the factors that influence the long-term prognosis in patients after myocardial infarction (MI) as a part of the prospective REGistry of pATients after myocArdial infarction (REGATA).Material and methods  In 2012-2013, 481 post-myocardial infarction patients were included into the REGATA registry; 247 (51.4 %) were men, median age 72 [62; 78] years. The median duration of prospective follow-up after the inclusion into the registry was 6.1 [4.0-6.6] years. Data were obtained for 474 (98.5 %) patients. Statistical analysis was performed with the Microsoft Excel 2010, StatsoftStatistica10.0 software and partially manually by formulas. Methods of descriptive statistics were used. For quantitative variables with normal distribution, mean values and standard deviations were calculated; intergroup differences were evaluated with Student's t-test. Differences between groups of survived and deceased patients were evaluated with a nonparametric method using the Pearson's chi-squared test with a Yates's correction, and the Fisher's exact test. When the frequency of absent data for the studied variable exceeded 20 %, this variable was not included into the analysis. The 6-year survival was analyzed by the Kaplan-Meier method. Fatal outcomes were analyzed with the Cox proportional hazards regression model. Differences were considered significant at p<0.05.Results During the follow-up period, there were 200 (41.6 %) cases of all-cause death and 123 (25.6 %) cases of cardiovascular death; 39 (8.1 %) of patients had acute cerebrovascular disease (ACVD) and 36 (7.5 %) had recurrent myocardial infarction. The median time from the inclusion into the registry to death was 3.4 [1.6; 5.1] years. A higher risk of all-cause death was significantly associated with factors of age (one-year relative risk, RR, 1.03; 95 % confidence interval, CI, 1.02-1.05; р<0.001), III-IV functional class angina (RR, 1.76; 95 % CI, 1.22-2.53; p=0.003), history of ACVD (RR, 2.12; 95 % CI, 1.50-2.98; p<0.001), atrial fibrillation (AF) (RR, 1.52; 95 % CI, 1.10-2.12; р=0.01), diabetes mellitus (DM) (RR, 1.53; 95 % CI, 1.11-2.10; p=0.009), chronic obstructive pulmonary disease (COPD) (RR, 1.77; 95 % CI, 1.20-2.62; p=0.004), and reduced hemoglobin (RR, 2.09; 95 % CI, 1.31-3.33; p=0.002). A lower risk of death was associated with administration of antiplatelets (RR, 0.57; 95 % CI, 0.37-0.89; p=0.01), angiotensin-converting enzyme (ACE) inhibitors /angiotensin II receptor blockers (ARB) (RR, 0.51; 95 % CI, 0.33-0.78; p=0.002), and statins (RR, 0.48; 95 % CI, 0.34-0.67; p<0.001). A higher risk of nonfatal stroke during the follow-up was significantly associated with age (one-year RR, 1.05; 95 % CI, 1.01-1.09; р=0.02), history of ACVD (RR, 2.74; 95 % CI, 1.33-5.63; p=0.006), and DM (RR, 2.43; 95 % CI, 1.17-5.06; p=0.02), and a higher risk of nonfatal stroke was significantly associated with a history of ACVD (RR, 1.70; 95 % CI, 1.44-2.01; p<0.001), DM (RR, 2.33; 95 % CI, 1.13-4.84; p=0.02), and COPD (RR, 2.47; 95 % CI, 1.02-6.00; p=0.06).Conclusion      In the outpatient REGATA registry that included patients with MI at any previous time, the death rate for 6 years of follow-up was 41.6 %. In 61.5 % of cases, death was caused by cardiovascular diseases. In clinical practice in long-term, a higher risk of unfavorable outcome was associated with old age, III-IV functional class angina, a history of ACVD, AF, DM, and COPD while a lower risk was associated with the administration of antiplatelets, ACE inhibitors/ARB, and statins.

Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study.

Aim    To study the etiology and the dynamics of prevalence and mortality of CHF; to evaluate the treatment coverage of such patients in a representative sample of the European part of the Russian Federation for a 20-year period. Material and methods    A representative sample of the European part of the Russian Federation followed up for 2002 through 2017 (n=19 276); a representative sample of the population of the Nizhny Novgorod region examined in 1998 (n=1922).Results    During the observation period since 2002, the incidence of major CHF symptoms (tachycardia, edema, shortness of breath, weakness) tended to decrease while the prevalence of cardiovascular diseases has statistically significantly increased. During the period from 1998 through 2017, the prevalence of I-IV functional class (FC) CHF increased from 6.1 % to 8.2 % whereas III-IV FC CHF increased from 1.8 % to 3.1 %. The main causes for the development of CHF remained arterial hypertension and ischemic heart disease; the role of myocardial infarction and diabetes mellitus as causes for CHF was noted. For the analyzed period, the number of treatment components and the coverage of basic therapy for patients with CHF increased, which probably accounts for a slower increase in the disease prevalence by 2007-2017. The prognosis of patients was unfavorable: in I-II FC CHF, the median survival was 8.4 (95 % CI: 7.8-9.1) years and in III-IV FC CHF, the median survival was 3.8 (95 % CI: 3.4-4.2) years.

[Empagliflozin and heart failure: position paper of the experts on the results of the online meeting and discussion of the EMPEROR-Preserved Trial].

At an international online expert meeting held on September 16, 2021, the results of the empagliflozin research program EMPA-REG Outcome, EMPEROR-Reduced and EMPEROR-Preserved were reviewed. We analyzed cardiovascular and renal outcomes during the treatment with empagliflozin in patients with chronic heart failure, regardless of the presence of type 2 diabetes mellitus. The positive results of the EMPEROR-Preserved study are updated and their significance for clinical practice is discussed. Several proposals have been adopted that will accelerate the introduction of empagliflozin therapy into practice in patients with heart failure and overcome clinical inertia.

[Adherence to the treatment of pa-tients in the long-term supervision period after myocardial infarction (according to the REGATA register)].

Aim To study long-term compliance with treatment in patients included into the REGistry of pATients after myocArdial infarction (REGATA).Material and methods In 2012-2013, the study included 481 patients with a history of myocardial infarction (MI) who visited the district outpatient clinic. Median age was 72 [62;78] years; men, 51.4 % (n=247); median time from the last MI to the date of inclusion into the registry was 5 [2;9] years. Compliance with treatment was determined with the Morisky-Green questionnaire during telephone contacts with patients at 36 and 48 months (n=230) after the inclusion. Patients scored 4 were considered compliant; patients scored 3 were low-compliant; and patients scored 0-2 were non-compliant. Statistical significance of differences in compliance at 36 and 48 months was assessed with the McNemar test.Results There were no significant differences between the proportions of compliant, low-compliant and non-compliant patients for the analyzed period. However, at 48 months after the inclusion, the number of patients who had difficulties in answering the questionnaire questions significantly increased from 15.5 % to 21.6 % (p=0.04). Analysis of changes in compliance with the treatment for only compliant patients showed that at 36 months from the inclusion, 87 patients remained highly compliant (37.8 %) while at 48 months, only 32 (36.8 %) patients remained compliant with the treatment. Proportion of compliant patients did not significantly differ for men and women, patients younger and older than 60 years, patients with primary MI and reinfarction, prone and not prone to self-management, and for those who used or not the medicine assistance.Conclusion The data obtained as a part of the REGATA registry indicate insufficient long-term compliance with the treatment of after-MI patients with both primary MI and reinfarction, an increasing proportion of patients who are unable to assess their degree of compliance, and decreasing compliance among highly compliant patients during the period between 36 and 48 months of observation. On the whole, there were no significant changes in the compliance with the treatment for 12 months between the first and the second interviews. The proportion of patients compliant with the prescribed drug therapy was significantly lower in the presence of predisposition to self-management.

[Myocardial Infarction in Women of Reproductive age: Risk Factors, Clinical Picture, Prognosis].

Aim        To study risk factors (RF) and clinical and anamnestic features of the course and prediction in women with a preserved menstrual cycle and postmenopausal women after ST segment elevation (STEMI) and non-ST elevation myocardial infarction (NSTEMI).Material and methods        This study included 121 women aged 32 to 55 years diagnosed with MI. The patients were divided into two groups, group 1 (study group) consisting of 60 women with preserved menstrual function (1А, STEMI; n=38; age, 48.3±5.7 years and 1B, NSTEMI; n=22; age. 49.0±4.8 years), and group 2 (control) consisting of 61 postmenopausal women (2А, STEMI; n=43; age, 49.05±4.9 years; 2B, NSTEMI; n=18; age, 49.9±3.5 years). Beside the analysis of RF and clinical features, a prediction was produced for each subgroup at one year after discharge from the hospital based on the following indexes: hospitalization for unstable angina, non-fatal MI, revascularization, cardiovascular (CV) death, and major adverse cardiac events (MACE), which included all these outcomes.Results   In all subgroups, the most frequent RFs were arterial hypertension (AH), overweight and obesity, family history, smoking, and type 2 diabetes mellitus (DM2). Among patients with STEMI, smoking was significantly more frequently observed in the group with preserved menstrual function. Oral contraceptives were used by 3 and 6 women of reproductive age in the STEMI and NSTEMI subgroups, respectively. Incidence of STEMI as the onset of ischemic heart disease (IHD, 46.7%) was higher than in subgroup 2A (27.9 %; р=0.003). Early postinfarction angina was a more frequent complication of MI in subgroup 1A than in 2A (р=0.02).Conclusion            The incidence rate of RFs, including AH, overweight and obesity, dyslipidemia, family history, and DM2, was similar in both STEMI and NSTEMI groups. Incidence rate of smoking was statistically significantly higher in subgroup 1A. One-year prediction for women with STEMI and NSTEMI was comparable irrespective of the presence or absence of the menstrual function.

[The medical social importance of functional disorders under chronic obstructive disease of lungs].

The chronic obstructive disease of lungs is considered as important problem of modern public health system. The disease is increasingly keenly reflected in agenda of our society, economic and social sphere of the state. The steadily progressing course of disease, disability and increasing economic costs assigns task of finding and improving diagnostic methods in real clinical practice. The purpose of the study is to assess the medical social significance of new approaches to studying functional status of patients with chronic obstructive disease of lungs in routine clinical practice. The sampling of 105 males were examined: 64 patients with chronic obstructive disease of lungs and 41 volunteers from control group without any diseases of respiratory system. All examined patients underwent spirometry, sixth minute step test, analysis of heart rate variability and test with external peripheral vascular occlusion. The study results established high level of importance of complex assessment of functional status of patients in routine clinical practice. The patients with chronic obstructive disease of lungs with respiratory failure demonstrated persistent hyperactivity of ergoreflex during test with external peripheral vascular occlusion. Therefore, method of assessing ergoreflex according to heart rate variability indices is applicable in clinic and has perspectives of implementation as mode of additional diagnostics of functional disorders.

EPOCHA-AH 1998­2017. Dynamics of prevalence, awareness of arterial hypertension, treatment coverage, and effective control of blood pressure in the European part of the Russian Federation.

AIM: To perform a repeated epidemiological study of a representative sample in the European part of the Russian Federation in 2017 and to compare the dynamics of arterial hypertension (AH) prevalence with the effectiveness of blood pressure (BP) control in the population compared to 1998, 2002, and 2007. MATERIALS AND METHODS: A representative sample of the European part of the Russian Federation was created in 2002 and re-examined in 2007 and 2017. In 1998, a pilot project was performed for examining a representative sample for the Nizhniy Novgorod region. RESULTS: During 19 years of follow-up, the AH prevalence increased from 35.5 to 43.3%. Te awareness and treatment coverage reached 76.9 and 79.3%, respectively, in 2017. Achievement of the target BP with a single measurement also increased among patients receiving antihypertensive medication from 14.3 to 34.9%. For the treatment of AH, medium-acting antihypertensive drugs are used, ofen at suboptimal doses. CONCLUSION: Epidemiological indices of awareness, treatment coverage, and number of effectively managed patients with AH have improved. However, the AH prevalence has increased by 7.8% for 19 years, which indicates inefciency of the primary prevention of this disease.

[Comparative analysis of mortality from acute forms of ischemic heart disease during a 15-year period in the Russian Federation and the United States and the factors influencing its formation]. / Sravnitel'nyi analiz smertnosti naseleniia ot ostrykh form ishemicheskoi bolezni serdtsa za piatnadtsatiletnii period v RF i SShA i faktorov, vliiaiushchikh na ee formirovanie.

AIM: To comparatively analyze the registered mortality rates from coronary heart disease (CHD) as a whole, as well as myocardial infarction (MI) and other acute forms of CHD during a 15-year period in the Russian Federation (RF, 2000-2014) and the United States of America (USA, 1999-2013). MATERIAL AND METHODS: Primary data were obtained from the database of the RF State Statistics Service, the World Health Organization Mortality Database, Human Mortality Database, then converted into standardized mortality rates and are presented in three age groups (30+, 30-49, and 50+ years old) in men and women separately. RESULTS: The analysis revealed a substantial excess of the registered mortality rates from CHD in the RF versus in the USA, as well as a lower incidence of MI and a higher incidence of other acute CHD forms registered as the cause of death. It also showed considerable differences in the structure of registered types of MI as the cause of mortality. CONCLUSION: The differences found in the mortality rates from CHD, MI, and other acute forms of CHD in the RF and the USA can be explained by objective (the higher prevalence of cardiovascular risk factors, the higher and earlier incidence of CHD in the RF, as well as differences in the organization of medical care and, as a result, actually higher mortality rates from CHD in Russia) and subjective (differences in approaches to statistically developing a population-based mortality rate, as well as defects in filling out the medical documents and coding the causes of death) factors.

[The Modern Aspects of Diagnosis Formulation and Statistical Recording of Myocardial Infarction].

The modern principles of myocardial infarction diagnosis formulation, recording, and statistical coding are discussed in the article. It contains material on terminology, clinical classifications and practical aspects of use of 10th revision of the International statistical classification of diseases and related health problems.

[THE QUALITY OF EXAMINATION OF PATIENTS WITH ARTERIAL HYPERTENSION BASED AT OUTPATIENT FACILITIES].

AIM: To analyze the quality of application of diagnostic methods in patients with arterial hypertension (AH) based at outpatient facilities in comparison with equipments of national clinical recommendations. MATERIALS AND METHODS: The study was conducted in the framework of the outpatient registry of cardiovascular diseases (REKVAZA). It included analysis of outpatient medical cards of 2850 patients with AH examined in two municipal polyclinics. Men accounted for 27.8% of the total. Patients with associated clinical conditions for 79.6%. Age median (interquartile range) for men and women was 64.8 (56.8; 74.8) and 70.6 (60.1; 77.6) years respectively. RESULTS: It was shown that the scope of real physical examination (measurements of height, mass, waist circumference, BMI) was below the target level (p < 0.001). Results of complete blood cell count for the previous 12 months could be found only in 71.7% of the cards, data on blood glucose level in 61/7%, total cholesterol in 42.7%, creatinine in 45.4%, results of ECG in 59.9%, echoCG in 9.5%, 24hr AP monitoring in 0.3%. Instrumental and laboratory studies were more often performed in patients with associated clinical conditions (p < 0.05). CONCLUSION: This study revealed poor quality of examination (physical, Instrumental and laboratory) of patients with arterial hypertension based at outpatient facilities.

[The Possibilities of Pharmacological Correction of Endothelial Dysfunction in Patients With Arterial Hypertension].

OBJECTIVE: To assess the possibility of a fixed combination of perindopril arginine and amlodipine in the correction of endothelial dysfunction (ED) in patients with arterial hypertension (AH). MATERIAL AND METHODS: The study included 49 patients with hypertension and ED receiving any antihypertensive therapy and have not reached the target level of blood pressure--blood pressure (66% women, 34% men). The mean age was 46.2 ± 5.4 years. Patients switching to visit prescribed combination of perindopril arginine and amlodipine in different dosages depending on the level of blood pressure. The study lasted 12 weeks, on the first and last visit was assessed endothelial function. RESULTS: All patients completed the study. Mean systolic and diastolic blood pressure decreased during the 12 weeks to 162.6 ±11.4 to 131.1 ± 10.0 mmHg and 95.4 ± 10.2 to 78.7 ± 7.7 mm Hg respectively (p < 0.05). At the time of the telephone contact was a target mean arterial pressure (p > 0.05). The structure of the DE before the study was as follows: DE major arteries or resistance--28.6%; DE both types--71.4%. After 12 weeks in patients receiving the drug in only 57.1% of the subjects had both types of ED (p < 0.05), DE or large resistive arteries was recorded in 21.4% of patients, while 21.5% were no signs of ED. The number of patients with hypertension who have reached the target blood pressure in patients receiving perindopril arginine and amlodipine increased from visit to visit, and reached 71.4% at 12 weeks. Over the 12 weeks of treatment adverse events occurred only in 2.1-4.2% of cases. CONCLUSION: Combination therapy with ACE inhibitor perindopril arginine and a calcium channel blocker amlodipine in people of working age with hypertension and ED for 12 weeks leads to a reduction of endothelial dysfunction of large and small vessels (from 71.4 to 57.1%), a significant reduction in systolic and diastolic blood pressure and achieve target blood pressure in 71.4% of cases.