Aim. To evaluate the quality of drug treatment of patients with cardiovascular diseases (CVD) at the remote stage of follow-up after hospitalization for new coronavirus infection (COronaVIrus Disease 2019, COVID-19) within the framework of the prospective TARGET-VIP registry.Material and methods. 1,130 people were included in the registry. The 473 (54.8%) patients with CVD were selected of the 863 patients discharged from the hospital with a diagnosis of COVID-19.Results. The frequency of proper prescriptions of medicines upon discharge from the hospital was 60%, after 3 years this indicator decreased to 41.4% (p<0.001). During the 3-year follow-up, a clear trend was recorded in a decrease in the frequency of intake of all drugs, while for some groups of drugs this decrease reached statistically significant differences. The frequency of taking angiotensin converting enzyme inhibitors in patients with cerebral stroke, statins in coronary heart disease and statins in patients with cerebral stroke MI did not change significantly, although the frequency of taking these drugs at all stages of follow-up was very low and did not exceed a third of the required prescriptions. New CVD were detected in 51 patients, and the average frequency of taking proper medications for CVD was higher than in patients with already known stable CVD, 74.2% and 66.2%, respectively, p=0.047. The presence of CVD did not affect the quality of therapy in the new cases of CVD, the average frequency of taking the necessary drugs in these groups was 77.8 and 63.2%, respectively, p=0.074.Conclusion. The quality of CVD therapy was insufficient at all stages of long-term follow-up: the frequency of proper prescriptions upon discharge from the hospital was 60%, after 3 years this indicator decreased to 41.4%. A clear trend was revealed in a decrease in the frequency of taking all drugs, while for some groups of drugs this decrease reached statistically significant differences. The quality of cardiovascular pharmacotherapy was higher with the appearance / development of new CVD in comparison with the group of stable patients with CVD, there was no significant improvement in the quality of therapy for previously observed CVD.

The article defines the original drug (OD) and examines the history of the appearance of generic drugs (GD), as well as the evolution of views to prove their bioequivalence to OD. The question is considered to what extent pharmacokinetic equivalence can guarantee the clinical equivalence of OD and GD. The data on the rules of registration of GD in different countries are provided. A brief overview of various types of studies comparing the clinical efficacy and safety of OD and GD (meta-analyses, randomized controlled trials, observational studies, description of clinical cases) and their main results is given. The results of a number of observational studies on the replacement of OD with GD and its consequences are presented. The existing system of current quality control of GD is described, numerous cases of recall of GD due to detected violations during their production are given. It is mentioned about individual cases of clinical inefficiency of GD and their side effects identified by the practical physicians. It is concluded that a qualitatively produced GD with proven pharmacokinetic equivalence to OD is able to provide therapy of the same quality as OD. However, numerous cases of the appearance of GD on the pharmaceutical market, which does not correspond to the quality of OD, make us somewhat wary of therapy based on VP. Both the practitioner and the patient should know which of the drugs prescribed by the international nonproprietary name is OD and which is GD.

Aim. To study the long-term prognosis of patients’ life who have suffered cerebrovascular accident (CVA), and to determine the role of diabetes mellitus (DM) as a possible negative prognostic factor, according to the outpatient follow-up stage in the REGION-M registry.Material and methods. The outpatient part of the REGION-M registry included 684 patients assigned to the Moscow City Polyclinic No. 64, discharged from the hospital in the period from 01.01.2012 to 30.04.2017 with a confirmed diagnosis of CVA, of which 122 patients (17.8%) were diagnosed with DM. The polyclinic stage included three observation points: 2017, 2020, and 2022. Data on the life status of all patients were obtained by telephone survey, if it was impossible to establish contact with the patient or his relatives, a unified medical information and analytical system was used to determine the life status of patients. The study patients were observed on an outpatient basis for more than 5 years (ME 1958 (751; 2555) days), the primary endpoint was death from any cause.Results. Information about the life status was obtained for all 684 patients. By the end of the observation, 415 cohort members had died, and 269 were alive. The average age of patients with DM was significantly higher than that of patients without DM: 71.5±10.9 years vs 68.0±14.7 years (p<0.05). The proportion of women in the cohort of DM patients was significantly higher than in the cohort of patients without DM: 72.1% vs 55.2% (p<0.05). Patients with DM were statistically significantly more likely to have a history of comorbid diseases (coronary heart disease, myocardial infarction, arterial hypertension, kidney disease and chronic lung disease, chronic heart failure). Obesity occurs with the same frequency in patients with and without DM. The studied groups of patients did not differ in types of CVA (transient ischemic attack, ischemic, hemorrhagic stroke). According to Cox Proportional Hazards Regression Analysis at the outpatient stage of follow-up, no significant negative effect of DM on patients’ mortality with CVA was confirmed (relative risk =1.239 (95% CI: 0.975; 1.574), p=0.079).Conclusion. In the long-term follow-up of patients with CVA, there was no statistically significant adverse effect of DM on long-term survival.

Aim. To describe and analyze a series of cases of absolute non-adherence to treatment (ANA), as well as to study the relationship of the phenomenon of refusal of treatment with long-term adverse outcomes in patients with acute cerebrovascular accident (ACVA), according to the LIS-2 registry (Lyubertsy Mortality Study 2).Material and methods. The study analyzed the results of two stages of prospective follow-up of patients with acute cerebrovascular accident included in the LIS-2 registry (n=960). After 2.8 [2.1; 3.5] years, an examination, a survey, and an assessment of treatment adherence according to the original questionnaire were conducted in 370 patients. After 6.9 [6.1;7.7] years, the outcomes of these patients were evaluated. The survival analysis included death from all causes, nonfatal myocardial infarctions and repeated ACVA, and emergency hospitalization for cardiovascular diseases also. These are the components of the primary combined endpoint.Results. According to the results of the questionnaire, 23 (6,2%) patients replied that they did not take prescribed medications, i.e. they were absolutely not adherent to treatment. Absolutely non-adherent patients smoked more often (p=0.004), were less comorbid, and had statistically significant difference in hypertension and coronary heart disease (CHD) (p<0.001 and p=0.03, respectively). The most common reason for ANA was unwillingness to take medications for a long time (n=12, 52,2%), the second most common reason was fear of drugs side effects and harm to health during long-term treatment (n=5, 21.7%). The components of the primary combined endpoint were registered in 10 (43.5%) absolutely non-adherent patients and in 104 (30.0%) people of the rest of the group. There was a discrepancy in the Kaplan-M ayer survival curves for the groups of absolutely non-adherent and all other patients, which did not reach statistical significance (p=0.12), as well as an increased risk of adverse long-term outcomes (hazard ratio, HR) in patients who completely refused treatment: HR=1.68, 95% confidence interval (CI) 0.87-3.21, p=0.12 (univariate Cox analysis). According to the results of multivariate Cox regression analysis, the predictors significantly associated with an increase in the risk of endpoints were ANA (HR=2.66, 95% CI 1.06;6.68, p=0.037); presence of coronary heart disease (HR=2.18, 95% CI 1.13;4.24, p=0.021); increase in age for each year (HR=1.08, 95%CI 1.04;1.12, p<0.0001).Conclusion. The phenomenon of complete treatment refusal or ANA was noted in 6% of cases in patients with ACVA. Its leading cause was the reluctance of patients to take medications for a long time. In patients with ACVA it has been shown that the presence of CHD and complete refusal of recommended treatment increases the risk of adverse long-term outcomes by more than two times.

Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.

The second publication is presented, devoted to the classification of the main parameters of quality and adherence to pharmacotherapy. Despite the fact that patients play a central role in the problem of medical adherence, the role of attending physicians is extremely significant both in prescribing/non-prescribing proven effective and safe therapy, and in influencing patient medical adherence. This led to the identification of a special commitment type — the physician adherence to the basic principles of rational treatment. Collection, analysis and systematization of information, as well as the related development of a classification of physician adherence/non-adherence were the aim of this review and analytical work. We searched data using keywords among Russian and English-­language sources. When compiling the classification, categories of adherence/non-adherence were identified in accordance with the implementation by physicians of the main provisions of clinical guidelines for long-term therapy for patients with non-communicable diseases (NCDs), as well as following official drug labels reflecting data on clinical pharmacology, the main side effects, drug-drug interactions. The classification of physician adherence/non-adherence to implementing the principles of rational treatment of patients with NCDs can be used in the development of electronic medical decision support systems for providing therapy with proven effectiveness and safety in specific clinical situations. In addition, on the basis of the developed classification, checklists for monitoring by healthcare specialists of the implementation of the rational treatment of patients with chronic NCDs should be created.

Aim . To assess adherence to the recommended therapy at the stage of outpatient follow-up and its impact on long-term outcomes in patients after acute myocardial infarction based on the materials of the prospective PROFILE-IM registry. Material and methods . The PROFILE-IM register included 160 patients who applied to one of the polyclinics in Moscow after a myocardial infarction. The combined endpoint (CE) included death from any cause, cardiovascular events (nonfatal myocardial infarction, nonfatal cerebral stroke), emergency hospitalizations for cardiovascular diseases, significant cardiac arrhythmias. Patients' adherence to therapy was assessed using the original questionnaire "Scale of Adherence of the National Society of Evidence-based Pharmacotherapy" (NODF) and a direct standardized patient survey by a doctor about taking medications. Visits to the doctor were carried out every two months, data from the first year of patient follow-up are presented. Results . In a personal interview with a doctor, the ratio of the proportion of committed, partially committed and non-committed patients did not change significantly over the entire follow-up period, while the proportion of committed patients was 81-85%. The "NODF Adherence Scale" showed that the proportion of non-committed patients was about 10 times higher than with direct patient responses to the doctor, and the proportion of non-committed and partially committed patients remained high at all stages of follow-up (respectively 28% and 10% at the beginning of the study, 18% and 10% at the end of the study). Among the main factors of non-commitment, there was a decrease in the importance of forgetfulness and an increase in factors such as fear of side effects of medications, doubt about the need for long-term use of medications and well-being. A direct relationship of adherence with the male sex, the presence of hypertension, a feedback relationship with alcohol consumption was revealed. The risk of CE in non-committed patients was higher compared to the group of committed and partially committed patients (p<0.01). Conclusion . The proportion of non-committed and partially committed patients remained high at all stages of follow-up. There was a direct relationship between adherence to therapy with the male sex, the presence of hypertension in the anamnesis, and a feedback relationship with alcohol consumption. Low adherence to therapy significantly increased the risk of cardiovascular events.

Aim. To estimate the detection rate of heart failure (HF), using various diagnosis criteria, among patients aftr 12 months after hospital treatment for coronavirus disease 2019 (COVID-19). Material and methods . The study included 185 patients from the TARGET-VIP registry who came for a visit 12 months after hospitalization for COVID-19. To identify HF with reduced (HFrEF) and mildly reduced (HFmrEF) ejection fraction (EF), the European Society of Cardiology (ESC) criteria (2016 and 2021) were used. To identify HF with preserved EF (HFpEF), we used the ESC criteria (2016 and 2021), as well as the 2018 Russian guidelines and H2FPEF score. Results. In the analyzed group, there were no patients with EF <40%, while one patient had EF of 48% and 184 patients — ≥50%. The patient with EF of 48% was not diagnosed with HF due to the absence of HF signs and symptoms. The presence of HFpEF was confirmed in 31,4% of patients according to 2018 Russian criteria and 2021 ESC criteria (first version of the diagnosis), in 12,5% according to the 2016 ESC criteria, 11% according to ESC 2021 criteria (second version of the diagnosis) and in 2,2% on the H2FPEF score. The proportion of HF diagnosed for the first time according to the 2016 ESC criteria was 78% of the total number of HF cases. Conclusion. Among the examined patients 12 months after hospital treatment for COVID-19, there were no cases of HFrEF and HFmrEF. The proportion of HFpEF cases, depending on the diagnostic criteria used, varied significantly from 2,2 to 31,4%. The previously established diagnosis of HF was confirmed in 83% of cases at a visit 12 months after discharge from the hospital. Using the 2016 ESC criteria and the corresponding 2020 Russian Society of Cardiology guidelines, the proportion of newly diagnosed HF was 78% of all patients.

The review is devoted to a modern problem of polypharmacy. A universal definition and clear criteria for this concept have not yet been formed, but it is believed that this is the prescribing of at least 5 medications (M). The article discusses the frequency and main causes of polypharmacy, demonstrates its clear relationship with the age. The presence of overweight and obesity, multimorbidity, low physical activity, fragility are clearly associated with polypharmacy. Cognitive impairment, disability, long-term pain syndrome and malignant diseases also predispose to polypharmacy. The absence of a permanent attending physician, living in a nursing home, consulting with several specialists, poor management of medical records are associated with polypharmacy. It is believed that polypharmacy leads to a following number of adverse consequences: it increases the risk of falls, side effects of M, hospitalizations and even death. The main reason for this is the occurrence of various adverse interactions between M, including unpredictable ones, but the causal relationship of these phenomena with polypharmacy is not always proven. To study of adherence to prescribed therapy with polypharmacy is not an easy task, to date, there is no clear answer to the question whether polypharmacy affects adherence to drug therapy. The article presents in detail the problems of potentially irrational prescriptions, discusses the main methods of preventing and combating polypharmacy. Obviously, the most acceptable methods are the cancellation of drugs that are not indicated or contraindicated to the patient, and the prescribing of those drugs for which there are direct indications, but which the patient does not receive. The patient’s therapy should be individualized as much as possible, taking into account numerous factors related to the peculiarities of the disease course, the prognosis, the patient’s lifestyle, his physical and mental status.

Aim. To study the two-year survival rate of patients with various types of cerebrovascular accident according to the outpatient part of the REGION-M registry. Material and methods . The outpatient part of the REGION-M registry included 684 patients assigned to the City Polyclinic № 64, discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a confirmed diagnosis of stroke or transient ischemic attack (TIA). Of these, 514 (75,1%) patients had an ischemic stroke, 52 (7,6%) — a hemorrhagic stroke, and 118 (17,2%) — a TIA. Results. The lowest two-year mortality (11%) was observed in patients who underwent TIA (p<0,001) compared with ischemic and hemorrhagic stroke. The relative risk of death for ischemic stroke was 2,0 (95% confidence interval (CI): 1,13-3,55) (p<0,05), and for hemorrhagic stroke — 2,51 (95% CI: 1, 22-5,15) (p<0,05) relative to patients with TIA. Mortality in patients with ischemic or hemorrhagic stroke did not differ significantly — 32,3 and 36,6% (p>0,05). The mean age of patients who underwent TIA was significantly less than the age of patients with hemorrhagic or ischemic stroke. With increasing age, the survival of patients significantly worsened in all types of strokes. In addition, multivariate analysis adjusted for age showed remained significant effect of the stroke type on survival as follows: the relative risk of death for ischemic and hemorrhagic stroke was 1,99 (95% CI: 1,12-3,53) (p<0,05) and 2,45 (95% CI: 1,19-5,02) (p<0,05). Conclusion. Mortality in patients with stroke was significantly lower after TIA than in any type of stroke and did not differ between subgroups of patients with ischemic and hemorrhagic stroke.

Aim . To assess the quality of life of patients with stable coronary heart disease (CHD) initially and 12 months after drug and non-drug secondary prophylaxis according to clinical guidelines. Material and methods . 73 patients (57 men, 16 women) with confirmed stable coronary artery disease were included in the study, of which 44 patients described a clinic for angina pectoris of functional class I-IV. The study included 2 patient visits: an initial treatment visit (V0) and a repeat visit after 12 months (V2). At both visits, blood pressure (BP), low-density lipoprotein cholesterol (LDL-c), quality of life (QL) were assessed using SAQ (Seattle Angina Questionnaire), drug therapy. Compliance with 5 basic principles of prevention was also assessed, which included: (1) healthy lifestyle (healthy lifestyle) (rejection of bad habits (smoking), moderate physical activity, lowcholesterol and low-carb diet); (2) normalization of body weight; (3) optimal drug therapy (the frequency of taking medications was evaluated using the original questionnaire); (4) achievement of target values of LDL-c in the entire group; (5) blood pressure in hypertensive patients. During V0, if necessary, drug therapy was adjusted in accordance with clinical recommendations. During V2, 57 patients (47 men and 10 women) were examined. The response was 80.8%. Results . After 12 months of follow-up, a statistically significant improvement in exercise tolerance (p=0.003), angina stability index (p=0.045) and the frequency of stress angina attacks (p=0.003) was noted when assessing the median of QL indicators. After 12 months of follow-up, 59% of patients used optimal drug therapy, including 4 drugs according to clinical guidelines. A healthy lifestyle (regular physical activity and smoking cessation) was achieved in 20.4% after 12 months of follow-up, the target level of LDL-c ˂ 1.8 mmol/L was achieved in 44.5% of patients, and the target blood pressure was achieved in 74,6%. The achievement of all 5 principles of secondary prevention of coronary heart disease according to the results of the work carried out by the visit after 12 months of follow-up was revealed only in 7% of patients (4 patients), and the implementation of 4 principles of prevention was noted in a quarter of patients from the group (24.5%, n=14). Conclusions . With drug and non-drug secondary prevention of coronary heart disease in patients with stable CHD after a year of follow-up, a statistically significant increase in QL indicators was noted due to increased exercise tolerance and a decrease in the frequency of angina attacks. Nevertheless, the basic principles of prevention were fully implemented only in 7% of patients.

The article provides a brief review of the guidelines on medical registries. The methodological recommendations are based on the accumulated clinical and scientific experience, data from domestic and foreign literature, expert consensus on the management of medical registers. The main types and goals of medical registers are described in detail. The issues of planning, management, development of documentation, conducting registers, preliminary preparation of data for statistical analysis are considered. The problems of quality and limitations of registries are highlighted, and the role of registries in the assessment of real clinical practice is defined.

Aim . To evaluate 24-month outcomes after hospital treatment of patients with coronavirus disease 2019 (COVID-19) in a prospective registry. Material and methods . Two-year outcomes (2,2±0,5) after hospital treatment for COVID-19 were analyzed in 802 patients (mean age, 59,8±14,5 years, men, 51,0%). We assessed cases of death, non-fatal myocardial infarction (MI) and stroke, revascularization operations, hospitalizations, recurrent COVID-19, vaccination for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results. During the follow-up period, 49 (5,9%) patients died, while 7 (0,8%) patients had MI, 7 (0,8%) — stroke. In addition, 222 (26,7%) patients were hospitalized, of which 26 (3,1%) for COVID-19. Recurrent COVID-19 were revealed in 146 (17,6%) patients, while 414 (49,6%) patients were vaccinated for SARS-CoV-2. The factors of age and stay in the intensive care unit were significantly associated (p<0,001) with the risk of all-cause death (hazard ratio (HR)=1,083 per 1 year of life and HR=6,28, respectively) and composite endpoint (death, non-fatal myocardial infarction, stroke, revascularization surgery): HR=1,057 and HR=3,28, respectively. Male sex was associated with the death risk (HR=2,50, p=0,003). Of the 49 deaths, 19 (38,8%) occurred in the first 3 months, and 35 (71,4%) in the first year of follow-up. A lower (1,8 times) incidence of new cases of cardiovascular (CVD) diseases and non- CVDs were associated with initial cardiovascular pathology. Hospitalization was associated with age (odds ratio (OR)=1,027; p<0,001) and CVDs (OR=1,66; p=0,01). The risk of recurrent COVID-19 was higher with CVDs (OR=1,55; p=0,03), lower — among those vaccinated for SARS-CoV-2 (OR=0,49; p<0,001). Conclusion. Over two-year follow-up of patients after hospital treatment for COVID-19, the proportion of deaths was 5,9%: >1/3 of deaths recorded in the first 3 months and >2/3 during the first year. Factors associated with death were age, male sex, and intensive care unit treatment during the hospitalization. The readmission rate was associated with older age and CVDs. The risk of repeated cases of COVID-19 was one and a half times higher in the presence of CVDs, but 2 times lower in those vaccinated for SARS-CoV-2 in the post- COVID-19 period.

Aim. To study the two-year survival rate of patients with cerebrovascular accident (CVA) in different age groups.Material and methods. The outpatient part of the REGION-M registry included 684 patients assigned to the City Polyclinic № 64 in Moscow, discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a confirmed diagnosis of stroke or transient ischemic attack. All patients were divided into 5 age groups: group 1 — from 18 to 50 years old (n=72 (10,5%)), group 2 — from 51 to 60 years old (n=122 (17,8%)), group 3 — from 61 to 70 years old (n=156 (22,8%)), group 4 — from 71 to 80 years old (n=185 (27,0%)) and group 5 — 81 years and above (n=149 (21,8%)). Patient survival was assessed after 2 years of follow-up.Results. The mortality rate of patients during the follow-up period significantly increased with age as follows: in patients of 18-50 years old — 4%, 51-60 years old — 9,8%, 61-70 years old — 23,7%, 71-80 years old — 34%, 81-100 years old — 55% (p<0,0001). The relative death risk was 2,3 in group 2 (NA), 6,8 in group 3 (p<0,001), 9,8 in group 4 (p<0,0001) and 18,5 in group 5 (p<0,0001) compared with group 1. With increasing age in the study cohort, the proportion of women increased as follows: from 47,2% in group 1 to 77,9% in group 5 (p<0,0001). However, mortality among men and women in the groups did not differ. Patients in older age groups were more likely to have comorbidities and disability before the CVA. With increasing age, ischemic stroke was significantly more common and transient ischemic attack was less common (p<0,001).Conclusion. Mortality of patients who underwent stroke was significantly higher in older age groups and did not differ among men and women.

Aim. To assess the survival rate of patients after cerebrovascular accident (CVA), depending on the visits to the local outpatient clinic and the type of medical supervision, and in the first year after hospital discharge. Material and methods . The outpatient part of the REGION-M registry included 684 patients assigned to the City Polyclinic № 64 of Moscow, discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a confirmed diagnosis of cerebral stroke/transient ischemic attack. Results. During the first year after the CVA, 451 (65,9%) patients visited the local clinic on their own (group 1), while 166 (24,3%) patients was consulted by house call (group 2), and 67 (9,8%) did not see the physician (group 3). Patients visited by house call were more likely to have prior coronary artery disease and stroke, and the age of men was older than in other groups. Patients who did not see a doctor were less likely to have comorbidities and disabilities, and were less likely to visit the clinic before stroke. The mortality of patients in group 3 was significantly higher throughout the entire follow-up period (55,2%, 70,1% and 77,6% at stages 1, 2 and 3 (p<0,001), respectively) than in group 2 (31,2%, 55,4% (p<0,001)) and group 1 (23,7%, 37,0% and 54,3% (p<0,001)). Mortality of patients in group 1 was lower than group 2 (p<0,05-0,01). The relative risk of death in clinic visitors was 0,450 (95% confidence interval (CI), 0,333-0,608, p<0,0001), while in those visited by a doctor at home — 0,668 (95% CI, 0,482-0,927, p<0,05). In multivariate analysis and adjustment for sex and age (relative risk (RR) of death, 0,08 (95% CI, 0,048-0,133), p<0,0001 and 1,036 (95% CI, 1,031-1,042), p<0,001, respectively), the independent contribution of the factor of clinic visits was preserved. Thus, the RR of death in visitors was 0,996 (95% CI, 0,994-0,999), p<0,001 and 0,998 (95% CI, 0,995-1,0), p<0,05. Conclusion. The lower mortality among those visited the local clinic in the first year after CVA and among those who were visited by a doctor at home, compared with patients who were not observed, confirms the important role of medical supervision in the post-hospital period.

Aim. To study the long-term survival of patients with cerebrovascular accident, depending on sex and age.Material and methods. The outpatient part of the REGION-M registry (patients with cerebrovascular accident, hospitalized in a Moscow hospital) included 684 patients assigned to the City Polyclinic № 64 (Moscow), discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a diagnosis of stroke, which were divided into 5 age groups: group 1 — ≤50 years, n=72 (10,5%), group 2 — 51-60 years old, n=122 (17,8%), group 3 — 61-70 years old, n=156 (22,8%), group 4 — 71-80 years old, n=185 (27,0%) and group 5 — ≥81 years old, n=149 (21,8%). The survival of patients was assessed at the 2nd and 3rd stages after 4,2 (2,4-5,6) and 5,5 (2,4-7,0) years.Results. The mortality of patients in the long-term follow-up period significantly increased with age. There were following mortality rate for stages 2 and 3 stages: 18-50 years old — 8,3 and 22,2%, 51-60 years old — 18 and 36,9%, 61-70 years old — 41 and 56,4%, 71-80 years old — 54,1 and 73%, >81 years — 76,5 and 87,9% (p<0,0001 for all groups). At stages 2 and 3, mortality among men was higher than among women in groups 2-4, below in group 1 and did not differ in the oldest age group. In multivariate analysis, the following factors had prognostic significance: age — hazard ratio (HR) of death, 1,035 (95% confidence interval (CI): 1,029-1,041, p=0,001), sex — HR, 0,720 (95% CI: 0,43-0,123, p=0,001) and disability before stroke — HR, 0,999 (95% CI: 0,998-1,000, p=0,002).Conclusion. In long-term follow-up, the mortality of patients with cerebrovascular accident was significantly higher in older age groups, as well as among men.