BACKGROUND:We conducted a multicenter, prospective, observational study to describe the incidence of orthostatic hypotension (OH) and orthostatic hypertension (OHtn) and its association with symptoms at standing and outcomes in patients with heart failure (HF). METHODS AND RESULTS:321 active standing tests were performed in 87 inpatients during admission, and 316 tests were performed in 208 outpatients during follow-up. Blood pressure (BP) was measured by an automatic device 4 times in the supine position and at 1, 3 and 5 minutes of standing. Patients were queried about symptoms of orthostatic intolerance. The incidence of OH and OHtn was similar in both groups at baseline (classical OH 11%-22%, OHtn 3%-8%, depending on definition and timing). Reproducibility of BP changes with standing was low. Up to 50% of cases with abnormal responses were asymptomatic. Symptoms were variable and occurred mainly during the first minute of standing and had a U-shaped association with BP changes. OH in outpatients with HF was associated with a higher risks of death or readmission due to HF. CONCLUSIONS:Patients with HF have variable hemodynamic responses and symptoms during repeated active standing tests. OH might identify outpatients with HF who are at risk of long-term negative outcomes.

This study focuses on the complex interplay of healthcare, economic factors, and population dynamics, addressing a research gap in regional-level models that integrate diverse features within a temporal framework. Our primary objective is to develop an advanced temporal model for predicting cardiovascular mortality in Russian regions by integrating global and local healthcare features with economic and population dynamics. Utilizing a dataset from the Almazov Center’s Department of Mortality Performance Monitoring, covering 94 regions and 752 records from January 1, 2015, to December 31, 2023, our analysis incorporates key parameters such as angioplasty procedures, population morbidity rates, Ischemic Heart Disease (IHD) and Cardiovascular Diseases (CVD) monitoring, and demographic data. Employing XGBoost and a regression model, our methodology ensures the model’s robustness and generalizability.

Abstract Purpose In a cohort, observational prospective trial, we assessed the long-term dynamics of sleep-disordered breathing in patients with resistant hypertension after renal denervation and their association with blood pressure change at remote follow-up. Materials and methods Twenty-eight patients with stable hypertension who were recruited for endovascular radiofrequency renal denervation in 2012–2019 and had valid both baseline and follow-up sleep study, were included in the analysis. All patients underwent physical examination, anthropometry, office and ambulatory blood pressure measurements, blood and urine tests, kidney visualization, and full polysomnography before and within 12–36 months after renal denervation. Results The average follow-up comprised 30.1 ± 8.4 months. At long-term follow-up, no significant changes in creatinine level, estimated glomerular filtration rate, body mass index were registered. There was a significant increase in sleep apnea severity indices: the mean change in apnea-hypopnea index comprised 9.0(-21.1;25.2) episodes/h, in oxygen desaturation index 6.5(-16.8;35.9) episodes/h, in the average SpO2 -1.7(-5.6;1.9)%. Over 12-month follow-up, there were no significant differences in blood pressure response in patients with and without sleep apnea. The baseline apnea-hypopnea and oxygen desaturation indices and the mean SpO2 were associated with the circadian blood pressure profile at follow-up, but did not correlate with the blood pressure response. Conclusions Although the severity of sleep apnea worsens at > 12 months follow-up after renal denervation, this is not associated with hypertension exaggeration.

The availability of patient-reported experience measures (PREM) is an unmet need in Russian healthcare. Objective: To translate, adapt culturally, and validate PREM for outpatients. Methods: A core set of questions from the Patient Experience Questionnaire (PEQ, in Norwegian, available in English) was translated to Russian (forward-backward translation). Acceptability, construct validity, and reliability were assessed. Patients aged >= 18 y.o. were invited to complete the questionnaire via QR-code within 24 h after a medical encounter. Results: A questionnaire with adequate conceptual and linguistic equivalence was obtained. For four questions, a rating scale was replaced by Likert-type. A total of 308 responses were received (median age 55 y.o., 52% females). The correlation matrix was factorable. Four factors were extracted using varimax rotation: 1) outcome of this specific visit; 2) communication experiences; 3) communication competency; 4) emotions after this visit. These explained 65.4% of the total variance. Three items were excluded. The model was confirmed to be adequate. The Cronbach alpha was >0.9. Item-total correlation confirmed discriminative validity. Conclusion: These preliminary results show that the Russian version of PEQ, adapted to national features, shows good psychometric properties. External validation is needed for the broad implementation of this PREM. Innovation: This research is first attempt to use PREM in the Russian Federation. The use of quick response codes is feasible and eases survey conduction. The more PREMs are used the higher the quality of healthcare.

The digitalization of healthcare relies heavily on data analytics from medical information systems. Such systems aggregate information from heterogeneous sources, including electronic medical records. Improving the quality of data from electronic medical records is a modern challenge for developers of medical information systems. The authors have designed a decision support system with an expanded set of auxiliary functions to solve the problems of human-computer interaction, increasing the completeness and reliability of medical information. In this paper, the applicability of the existing decision-making system is investigated on the example of medical data of patients with arterial hypertension. The testing of the decision support system among medical specialists was carried out. The impact of the implementation of the system on the number of errors when filling out an electronic medical record was assessed. A software module was created integrated into the working version of the medical information system in the Almazov National Medical Research Centre. Test implementation of the system made it possible to reduce the number of errors and increase satisfaction with the information presented in patients with arterial hypertension.

Aim: Guidelines recommend treating hypertension (HTN) by keeping office blood pressure (BP) within the therapeutic range (TR). However, little is known about the TR of home BP. Therefore, we aimed to find a reliable proportion of home systolic (S) BP in TR (sBPiTR) using a telehealth platform, which facilitates the access to reliable and structured home BP data. Methods: We used the data of HTN patients who participated in BP telemonitoring and counseling for 3 months. Patients had to manually enter their home BP in electronic diaries. Home SBP readings were averaged by the system itself except the very first or every first day of BP monitoring. We divided sBPiTR (110-130 mmHg) by quartiles. A weighted Cohen’s kappa coefficient was used as an estimate of inter-rater reliability between sBPiTR and office/home SBP in TR. We used a binomial logistic regression to test the predictive value of sBPiTR on target office/home SBP achievement. Results: In total, 123 patients were included (median age 54 years; 102 males) with a median office SBP of 140 mmHg. By 3 months, it decreased to 130 mmHg (P < 0.001), with 60% of patients with target office BP and 70% in the upper sBPiTR quartiles. There was a slight agreement between office SBP in TR and sBPiTR of ≥ 50% (k = 0.19, P < 0.035) and fair agreement when countered against home SBP in TR (k = 0.32-0.65, P < 0.0001). Patients with sBPiTR of ≥ 50% were more likely to fall within the office and home SBP TR after adjustment for baseline covariates. Conclusion: The threshold of 50% of home SBP measurements within 110-130 mmHg has a slight agreement with office BP control and a fair agreement with home BP control. This variable may serve as a predictor for the achievement of target SBP both in and out of office. Larger studies are needed to confirm these preliminary results.

On September 25, 2020, in St. Petersburg, a round table was held with the support of Abbott company "Tactics of management of patients with cardiovascular diseases", dedicated to a modern interdisciplinary approach to the management of patients with cardiovascular diseases (CVD) with the participation of leading Russian cardiologists. CVD are one of the leading causes of adult mortality in both developing and developed countries. The key issues in the management of patients with CVD include the high incidence of comorbidity, which, according to the cardiovascular continuum, has a mutual negative effect on the course and prognosis of diseases. CVD are most often associated with metabolic disorders such as metabolic syndrome and type 2 diabetes mellitus. Currently, there is a need to correct the existing approaches to the management of CVD patients with comorbid metabolic disorders in order to optimize and improve the effectiveness of measures by health professionals. The article is devoted to aspects of a modern interdisciplinary approach to the management of patients with CVD.

Objective: Telehealth is a useful adjunct in hypertension (HTN) management. Despite obvious short-term clinical benefit, long-term social impact and cost-effectiveness have not been fully investigated. The aim of the study was to perform predictive modeling of long-term clinical and social outcomes and to conduct a cost-utility analysis of blood pressure (BP) telemonitoring and remote counseling (BPTM) in patients with HTN. Design and method: A Markov cohort-based (n = 2000 patients) model was developed and adopted a 10-year time horizon with 12-month time cycles. Cost and outcome data collected from the three-month study of 240 patients (160 in BPTM group and 80 controls, 48 y.o.). All patients started at non-complicated HTN state then moving to disease complications with a certain transition probabilities over a discrete time period (1 Markov cycle). BPTM was compared with usual care in terms of lifetime costs, quality adjusted life years using a Ministry of Health of Russian Federation perspective. Results: At the end of a clinical part of the study there was a decrease in office systolic BP by -16,8 ± 2,9 mm Hg -7,9 ± 3,9 mm Hg in BPTM and usual care groups respectively. By the way, there was an improvement in health-related quality of life (measured with MOS SF-36) +16% and +4% in respective groups. In the long-term run when compared with usual care BPTM was more effective in terms mortality (67 versus 91 patients lost and 9,6 versus 9,71 life years gained) and costs (cost of illness 102 508 000 RUR versus 145 237 700 RUR). Taking quality of life measures into account, the effect of BPTM was also more pronounced (8,31 versus 7,82 QALYs). The resultant incremental cost-utility ratio for BPTM was 275 178,98 RUR/1 QALY gained/1 patient (134837,70 RUR/0,49 QALY/1 patient). Conclusions: According to the results of predictive modeling BPTM in clinical practice is likely to lead to reduced cardiovascular morbidity and mortality being also a cost-effective use of healthcare resources. Larger randomized clinical trials will give more information on BPTM cost-effectiveness in other middle-income countries.

Analysis of routine clinical practice of hypertensive patient management represents one of the important tools in the search for further ways to minimize hypertension-associated cardiovascular and renal adverse outcomes.AIM:To compare the strategies for hypertension management and features of clinical use of I1-imidazoline receptor (I1-IR) agonists in the Russian Federation and other countries where the STRAIGHT (Selective imidazoline receptor agonists Treatment Recommendation and Action In Global management of HyperTension) study was conducted.MATERIALS AND METHODS:It was a cross-sectional online study involving physicians of various specializations. The study was conducted from January 18 to July 1, 2019, in seven countries with a high rate of I1-IR agonist prescription, including Russia.RESULTS:A total of 125 (4.5%) responders filled out the survey in the Russian Federation, which was somewhat lower than in other countries (6.8%). The participants were mostly general practitioners (54.0%) and cardiologists (42.0%), while in other countries greater diversity was seen. Most Russian physicians (83.0%) seemed to rely on national clinical guidelines in their routine practice, while in other countries the US guidelines were more popular (66.0%). The majority of responders stated that they took into account the traditional risk factors of hypertension when initiating the therapy; every second responder noted if sleep apnea was present. Awareness of I1-IR agonists, their prescription rate and their preference were higher in Russia. The main reported benefits of I1-IR agonists were their efficacy, including in resistant hypertension, and their metabolic effects (in Russia). Most participants preferred I1-IR agonists as third-line therapy (65.0% in Russia vs 60.0% in other countries) and in combination with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blockers (ARB) (55.0% in Russia vs 54.0% in other countries). Compared to responders from other countries, Russian physicians prescribe I1-IR agonists as first-line (15.0% vs 5.0%) and second-line (48.0% vs 21.0%) therapy more often.CONCLUSION:Russian physicians were the most aware of I1-IR agonists and tended to prescribe drugs of this class for hypertension management more often, and I1-IR agonist combination with ACEi was preferable compared to physician responders from other countries. Antihypertensive efficacy and metabolic effects were reported as the major benefits of I1-IR agonist therapy.

Objective: Telehealth techniques are hugely involved in management of hypertension (HTN). Despite much evidence of clinical efficacy, the quality of life (QoL) is still poorly addressed in m-Health studies. Furthermore, generic tools are often used for QoL assessment. The aim was to assess QoL of blood pressure telemonitoring (BPTM) with the brand new HTN-specific patient-reported outcome measure called HYpertension imPact questionnairE (HYPE). Design and method: Conceptual model of HYPE was designed and the item pool was created by an expert panel consisting of 4 cardiologists, 2 psychologists. Validation survey was conducted in a 400-cohort of ambulatory patients with HTN Grades 1–3. Exploratory and confirmatory factor analyses (EFA and CFA respectively) were undertaken to confirm validity. Reliability was confirmed with Cronbach's alpha. Free and secure m-Health app was developed for BPTM. 100 patients were enrolled and allocated to BPTM (mean age 48 y.o.) and control (mean age 49 y.o.) in 1:1 ratio. The 6-month program was developed with baseline and end of study clinic visits and HYPE polling. Results: There were 5 factors (“symptoms”, “emotions”, “social issues”, “treatment efficacy” and “treatment adherence”) retained with respect to Cattel scree test. Of 80 initial questions only 35 were eligible due to EFA (factor loadings >0.5). CFA indicated SRMR was 0.08, RMSEA was 0.07 (90% CI [0.07–0.08]) and CFI was 0.08. Cronbach's alpha was more 0.80 for each of the factors and 0.89 for the whole scale confirming its reliability. Six-month results reaffirmed the clinical efficacy of BPTM (141,2 ± 10,2 vs 149,5 ± 8,4 mm Hg, p < 0.003). The vast majority of patients in BPTM achieved target office BP instead of control group (50% vs 15%). HYPE score was markedly higher in BPTM group than in controls (+22,4 [+16%] vs +5,6 [4%], p < 0.0001) at the end of the study. Qualitative substudy showed 70% positive patient experience with using BPTM. Conclusions: Novel patient-reported outcome measure is a solid tool for assessing different patterns of QoL in patients with HTN. BPTM seems to be effective especially in a patient-centered manner and paves the way for future telehealth studies focusing on quality of life in hypertensive subjects.

Heart failure (HF)is a condition at high risk for orthostatic hypotension (OH)given the large proportion of patients at an advanced age and high burden of comorbidities contributing to OH, as well as a high prevalence of medications with neurovascular and volume modulating properties. Early identification of OH in HF seems to be crucial as OH can have an impact on patient symptoms, activity level and independence, be a marker of specific pathophysiological changes or be an indicator of need for personalized treatment. OH might contribute significantly to bad enough prognosis in HF, as, besides a risk of falls and cognitive decline, it was found to be associated with cardiovascular morbidity and mortality. In this review, we aimed to incentivize the routine use of orthostatic testing in HF, as well as stimulate future research in this field, which could lead to significant advances in the treatment and outcomes.

Specific predictive models for diabetes polyneuropathy based on screening methods, for example Nerve conduction studies (NCS, can reach up to AUC 65.8 - 84.7 % for the conditional diagnosis of DPN in primary care. Prediction methods that utilize data from personal health records deal with large non-specific datasets with different prediction methods. Li et al. utilized 30 independent variables, which allowed to implement a model with AUC = 0.8863 for a Multilayer perceptron (MLP). Linear regression (LR) based methods produced up to AUC = 0.8 %. This way, modern data mining and computational methods can be effectively adopted in clinical medicine to derive models that use patient-specific information to predict the development of diabetic polyneuropathy, however, there still is a space to improve the efficiency of the predictive models. The goal of this study is the implementation of machine learning methods for early risk identification of diabetes polyneuropathy based on structured electronic medical records. It was demonstrated that the machine learning methods allow to achieve up to 0.7982 precision, 0.8152 recall, 0.8064 f1-score, 0.8261 accuracy, and 0.8988 AUC using the neural network classifier.

The current pandemic can likely have several waves and will require a major effort to save lives and provide optimal treatment. The efficient clinical resource planning and efficient treatment require identification of risk groups and specific clinical features of the patients. In this study we develop analyze mortality for COVID19 patients in Russia. We identify comorbidities and risk factors for different groups of patients including cardiovascular diseases and therapy. In the study we used a Russian national COVID registry, that provides sophisticated information about all the COVID-19 patients in Russia. To analyze Features importance for the mortality we have calculated Shapley values for the "mortality" class and ANN hidden layer coefficients for patient lifetime. We calculated the distribution of days spent in hospital before death to show how many days a patient occupies a bed depending on the age and the severity of the disease to allow optimal resource planning and enable age-based risk assessment. Predictors of the days spent in hospital were calculated using Pearson correlation coefficient. Decisions trees were developed to classify the patients into the groups and reveal the lethality factors.

PURPOSE:Blood pressure telemonitoring and remote counselling (BPTM) improves blood pressure (BP) control in patients with hypertension (HTN). Studies assessing the efficacy of BPTM from a value-based perspective are lacking. We investigated whether BPTM fits all principles of the value-based approach (clinical and economic effectiveness, improvement in patient-reported outcome/experience measures (PROM/PREM)). MATERIALS AND METHODS:Two hundred and forty ambulatory patients with uncontrolled HTN were randomised in a 2: 1 manner to BPTM (n = 160, mean age 47 y.o.) and usual care (UC, n = 80; 49 y.o.) with baseline and 3-month follow-up clinic visits. BPTM employed a mobile application (for patients) and a desktop version (for clinician), which allowed communication and exchange of medical data. The main outcomes were changes in office and ambulatory systolic (S) BPs, rate of BP control. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were evaluated in economic analysis. The MOS SF-36 score was taken as a PROM, and the PEQ score was used as a PREM. RESULTS:Larger decreases in office and ambulatory SBPs (-16.8 and -8.9 mm Hg, respectively; p < .05) was achieved in BPTM group while the treatment intensity was equal (2.4 drugs). The ICER 11.1 EUR/-1 mm Hg 24-hour SBP/1 year was 75% effective as per willingness-to-pay threshold. BPTM improved PROM (+2.1 in mean MOS SF-36; p = .04), reduced long-term mortality (+0.11 life years gained), leading to +0.49 quality-adjusted life years (QALYs) gained as compared with UC. The ICUR was 4 169.4 EUR/QALY gained. Patient-reported experience was higher in the BPTM (+10 PEQ, p = .01). The UC group showed minor changes in MOS SF-36 and PEQ (+1.3; +6, respectively; p n.s.). CONCLUSIONS:Being cost-effective, BPTM incorporates both clinical benefits and patient-perceived value. Larger randomised studies are needed to confirm our findings.

The outbreak of COVID-19 has led to a crucial change in ordinary healthcare approaches. In comparison with emergencies re-allocation of resources for a long period of time is required and the peak utilization of the resources is also hard to predict. Furthermore, the epidemic models do not provide reliable information of the development of the pandemic's development, so it creates a high load on the healthcare systems with unforeseen duration. To predict morbidity of the novel COVID-19, we used records covering the time period from 01-03-2020 to 25-05-2020 and include sophisticated information of the morbidity in Russia. Total of 45238 patients were analyzed. The predictive model was developed as a combination of Holt and Holt-Winter models with Gradient boosting Regression. As we can see from the table 2, the models demonstrated a very good performance on the test data set. The forecast is quite reliable, however, due to the many uncertainties, only a real-world data can prove the correctness of the forecast.

Objective. To investigate the dynamics of renal function in patients with resistant arterial hypertension after renal denervation depending on the degree of central and peripheral blood pressure (BP) reduction and the baseline state of the kidneys. Design and methods. A total of 22 patients (mean age 56,1 ± 10,2 years, 9 males) with treated resistant hypertension undergoing bilateral renal denervation (RDN) (Symplicity RDN System, Medtronic, USA) were included. Office BP measuring, 24-hour ambulatory BP monitoring (ABPM) (SpaceLabs 90207, USA), applanation tonometry (SphygmoCor, AtCor Medical, Australia) with the calculation of central aortic blood pressure (CAP), Doppler ultrasonography (Vivid 7 dimension) were obtained at baseline and at 1, 3, 6, 12, 18 and 24 months after RDN. Urine levels of NGAL (neutrophil gelatinase-associated lipocalin), KIM-1 (kidney injury molecule 1), L-FABP (Liver-type fatty acid binding protein), albuminuria and serum levels of сystatin C (sCysC) and creatinine (sCr) were measured by quantitative enzyme immunoassay at baseline and at 1, 3, 6, 12, 18 and 24 months after RDN. Glomerular filtration rate was estimated by the level of sCr and sCysC by CKD-EPI formula. Results. All patients were divided into 3 groups according BP reduction: 1 — BP increase above 0 mm Hg; 2 — BP reduction from 0 to –30 mm Hg; 3 — BP reduction by > 31 mm Hg. An increased sCysС was registered in a group with decreased 24-hour systolic BP (1,06 ± 0,41; 0,93 ± 0,18 and 1,22 ± 0,23 ng/mL; F = 2,882; р = 0,04) and increased urine KIM-1 level — in a group with decreased office diastolic BP (2,18 ± 1,94; 1,53 ± 1,02 and 4,41 ± 0,97 pg/mL; F = 3,663; р = 0,03) at 3-month follow-up. An increased sCr level was registered in a group with decreased 24-hour systolic BP (78,3 ± 3,7; 88,2 ± 6,8 and 142,00 ± 8,8 μmol/L; F = 61,987; p = 0,004) and diastolic CAP (83,4 ± 8,2; 82,0 ± 8,0 and 142,0 ± 9,4 μmol/L; F = 23,476; p = 0,01), also an increased urine L-FABP level — in a group with decreased office diastolic BP (3531,3 ± 1795,0; 997,5 ± 1096,8 and 7351,7 ± 3297,0 pg/mL; F = 12,103; p = 0,002) at 6-month follow up. Conclusions. Renal function worsening in patients during the period of maximum BP lowering may be associated with an excessive BP reduction. Therefore, we can suggest the occurrence of the J-curve phenomenon in relation to the kidneys.