Aim    To analyze the main reasons for the impairment of the life prognosis of patients with chronic heart failure (CHF) in real clinical practice of the Russian Federation.Material and methods    Representative samples of the population of the Nizhny Novgorod region (1998, n=1,922) and the European part of Russia followed from 2002 through 2017 (n=19,276), as well as randomly selected medical records of outpatients under the dispensary monitoring for CHF from 19 therapeutic and preventive medical institutions of three constituent entities of the Russian Federation (n=177, 2022) were analyzed for the adherence to therapy and the effectiveness of treatment. In addition, the prevalence, etiology, and prognosis of life of patients with CHF and acute decompensated heart failure (ADHF) were determined as a part of the EPOCH study.Results    The EPOCH-CHF study for the first time determined the true prevalence of CHF in the European part of the Russian Federation (8.2% by soft criteria) and 3.1% (by strict criteria). Furthermore, the prevalence of heart failure with reduced ejection fraction (EF) was 0.8%, moderately reduced EF was 0.9%, and heart failure with preserved EF was 1.4% of all studied patients in whom HF was defined by strict criteria. The EPOCH-CHF and EPOCH-Hospital Stage studies confirmed that a long-term exposure of the body to arterial hypertension and ischemic heart disease significantly influenced the development of CHF. At the same time, acute myocardial infarction, diabetes mellitus and uncorrected heart defects can induce severe CHF within a short period. The life prognosis of patients both after ADHF and with stable CHF in the Russian Federation is very poor. Within 4 years, 55.2% of patients after ADHF die; no patient with III-IV FC CHF survives longer than 10 years; and patients with I-II FC CHF are at a 75% risk to die after 16 years of follow-up. This is related with an ineffective use of basic drugs and uncoordinated follow-up of patients.Conclusion    The analysis of three studies showed a high level of coverage of CHF patients with therapy but a low level of compliance with national guidelines, which is reflected in the use of low doses of drugs, the lack of effective hemodynamic control and, as a consequence, a poor prognosis for CHF patients with CHF, regardless of its stable course or acute decompensation.

Oncologic disease and concomitant treatment are among the main triggers for Takotsubo syndrome. A clinical case of Takotsubo syndrome in cancer is presented. Thyroid carcinoma and thyroidectomy contributed to the development of Takotsubo syndrome. The clinical manifestations are similar to those of acute myocardial infarction. Coronarography is important in the differential diagnosis. Patients with cancer are at high risk of developing Takotsubo syndrome and should be under close clinical observation. A patient with Takotsubo syndrome should be hospitalized in an intensive care or cardiac intensive care unit. The management and treatment of patients with this pathology should be discussed by a multidisciplinary team.

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 11453 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.

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.

Abstract Aim The present study shows the dynamics of the prevalence different grades of AH and treatment coverage over15 years of observation. Methods 8740 apartments were randomized in 2002 year in eight regions of Russia and 19449 individuals were included. Re-examination was carried out in 2017 year. The representative sample was separated in four groups: Grade 0 – individuals with systolic blood pressure (BP) <140 mm Hg and diastolic blood pressure <90 mm Hg; and three Grades of arterial hypertension (AH) in accordance with European guidelines. Also, we select patient with and without antihypertensive drug treatment (AHDT). Results The mean age individuals was 44.4±19.3 years in 2002 year. Grade 0 had 63.3% participants (mean age 36.5±17.1 y.), Grade 1 – 19.5% (mean age 55.2±15.4 y.), Grade 2 – 11.7% (mean age 60.6±13.5 y.) and Grade 3 – 5.6% (mean age 62.4±12.8 y.). 3.0% participants had AHDT and blood pressure meets Grade 0. Patients with AH Grade 1 used drugs in 25.5% cases, with Grade 2 – 49.4% and with Grade 3 – 60.8% patients respectively. The mean age of participants with AHTD was significantly higher than mean age group without AHTD in Grade 0, 1 and 2 (p<0.001). In group Grade 3 mean age was not difference (p=0.16). The mean age individuals (51.3±16.9 y.) in 2017 year was significantly higher on 6.9 years than mean age in 2002 year (p<0.001). The proportion of patients with AHDT in all grades groups in sample 2017 year were significantly higher than in sample 2002 year (Table). The prevalence of AH in 2002 y. amounted to 38.6%. In 2017 y. prevalence of AH was significantly higher – 41.4% (p<0.001). Structure of samples Grade 2002 2017 AHDT Mean age AHDT P value Mean age 0 63,3% No 35,8±16,8 70,1% 42,6±13,9 Yes 3,0% 57,4±14,5 16,3% <0,001 63,6±12,0 1 19,5% No 53,3±15,7 23,6% 57,3±13,3 Yes 25,5% 60,9±13,0 68,4% <0,001 66,3±11,3 2 11,7% No 58,5±14,2 5,4% 58,0±14,9 Yes 49,4% 62,7±12,3 80,6% <0,001 66,5±11,5 3 5,6% No 61,7±13,9 1,0% 63,6±17,6 Yes 60,8% 62,8±12,0 71,1% 0,03 66,0±12,8 ALL 100% 44,4±19,3 100% 51,3±16,9 AHDT: antihypertensive drug treatment. Conclusion Over 15 years follow up period the prevalence of hypertension in Russia increased to 41.4%, but the effectiveness of therapy remains low.

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.

The aim of the investigation was to study the prehypertension prevalence depending on gender and age, state its dynamics and determine the frequency of combinations of various risk factors in European Russia population from 2002 till 2007.Materials and Methods. Population in nine European Russian subjects was randomized in 2002. The respondents included in the sampling were examined by outpatient physicians. The prevalence of prehypertension and a number of risk factors in respondents were reanalyzed 2007.Results. 286 outpatient physicians examined 6780 families (14 555 respondents). Prehypertension prevalence in 2002 was 13.7% of the population size, in 2007 the prevalence reached 16.9% (p<0.001). Prehypertension develops reliably more frequently in men than in women that subsequently predetermines earlier formation of arterial hypertension and cardiovascular complications. Age-specific prehypertension prevalence in RF increases in the period from 10 to 60 years, men preserving priority. The number of prehypertensive respondents with three and more risk factors did not change significantly over the period of five years and was 84.2% in 2002 and 65.2% - in 2007.Conclusion. Prehypertension prevalence in the Russian Federation is high, over 60% of respondents have normal or high normal arterial pressure level and three and more hypertension risk factors that is a major medical and social problem for the country.

In recent years great success has been achieved in clarifying the pathogenesis of ventricular tachycardia (VT) [1], and in suggesting corrective methods [2]. Along with that, problems have arisen in the treatment of VT, including side effects and resistance to antiarrhythmic drugs. Initiation of these arrhythmogenic effects has forced researchers to study the mechanisms of VT development and to search for new ways of treatment. The signal averaged ECG (SAECG) method is being widely disseminated. The method reveals late ventricular potentials (LVP) [3]. Antiarrhythmic drugs can change the parameters of the SAECG and have an effect on the LVP [4]. So an opportunity appears to decrease the risk of fatal VT, and of sudden cardiac death as its main complication. Nevertheless, the problem of the influence of antiarrhythmics has not been studied in detail. Examination of heart rate variability using spectral analysis (SAHRV) [5], and variable parameter changes under the influence of antiarrhythmic drugs [6] have a great value for investigating VT-initiated mechanisms. They may help to treat patients with arrhythmia in more appropriate ways and evaluate the effects of antiarrhythmics. Our goal was to examine the SAECG and SAHRV parameters of patients with VT of different etiologies, clarify the influence of etmozin, propaphenon and propranolol on these parameters, and formulate a different approach to prescribing antiarrhythmic drugs for VT patients.