Introduction. Stroke remains one of the leading causes of death and persistent disability of the population worldwide, with the highest risk among the elderly (60–74 years old) and senile (75 years and older). Due to the global aging of the population, the problem of effective primary prevention becomes critically important for maintaining the health and quality of life of this category of patients. The purpose of the literature review. To systematize and characterize the main directions and practical measures of primary stroke prevention aimed at preventing the first acute cerebrovascular accident in patients of older age groups. Basic principles. Primary stroke prevention is based on the timely identification and correction of risk factors, which are divided into non-modifiable (age, gender, and heredity) and modifiable (those that can be influenced). In older adults, the focus is on managing modifiable factors.

Secondary prevention of stroke in elderly and senile people is aimed at correcting risk factors, using drug therapy and lifestyle changes, as well as at rehabilitation after stroke. The goal is to prevent a second stroke in the first 24–48 hours after an acute cerebral ischemic attack. The review of literature on secondary prevention of stroke in elderly and senile people includes studies on risk factor correction, drug therapy, recommendations for lifestyle changes and rehabilitation.

Acute coronary syndrome in elderly patients is a serious medical and social problem, the relevance of which is increasing in the context of demographic aging of the population. Optimization of antithrombotic therapy in this category of patients is of particular importance, taking into account hemodynamic parameters, age-related changes in the pharmacokinetics and pharmacodynamics of drugs, the presence of polymorbidity, and an increased risk of hemorrhagic complications. The results of the study demonstrate comparable hemodynamic stability and good tolerability of antiplatelet drugs in different age groups, which is of great practical importance for optimizing therapeutic approaches.

The article is devoted to the problem of disability of the adult population due to aortic valve disease. The results of the study are presented, which revealed the trends in the dynamics, age and gender characteristics of disability due to rheumatic disease of the aortic valve and its non-rheumatic lesion in the adult population of Moscow in the period 2017-2023. It is demonstrated that non-rheumatic genesis of persistent health disorders, in particular, aortic valve stenosis prevails, and age older than the working age is a risk factor for disability due to this pathology.

The article analyzes the indicators of disability due to rheumatic heart disease in the Russian Federation in dynamics in 9 years. Its structure is represented on the basis of age and disability groups.

The article provides a review of the literature on aortic valve damage in elderly patients. Patients with heart valve defects are a large group of patients, mainly the elderly and senile, in whom the development of heart failure is most predictable. Sudden death in patients with valvular pathology is quite common, even in the absence of additional risk factors, so all these patients have a high risk of death, especially with prolonged conservative treatment.

BACKGROUND: Sensory impairments are included in screening instruments for frailty, are highly prevalent among older adults, but have been scarcely analyzed among patients with frailty syndrome. AIM: This study aimed to assess the prevalence of frailty depending on the presence of sensory deficits in older age. METHODS: The study included 354 patients. Frailty was assessed using the Fried Frailty Phenotype scale. Sociodemographic characteristics, health status, and behavioral data were collected. Analyses were performed using Statistica 10.0. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. RESULTS: Sensory difficulties were most frequently reported (58.1%), followed by cognitive, physical, and nutritional impairments (15.3%, 12.7%, and 1.9%, respectively). The prevalence of frailty syndrome was 19.5% (95% CI 15.2%–23.5%). Most participants in whom frailty syndrome was identified reported problems with vision or hearing. Frailty syndrome was associated with female sex, older age, very poor perceived health, depression, low body weight (body mass index ≤ 18.5 kg/m2), and a higher burden of comorbidity. CONCLUSION: Incorporating sensory deficits into the definition of frailty significantly increases the number of identified individuals with this syndrome.

The article presents the materials of a study on the quality of life of elderly patients with aortic valve damage using the SF-36 questionnaire (Short Form-36 Health Survey), which is one of the most common tools for assessing the quality of life related to health. The SF-36 questionnaire includes 36 questions combined into 8 scales, and also allows you to calculate 2 total indicators — physical (PCS) and mental (MCS) components of health.

The article presents the results of the study of senile asthenia syndrome in elderly patients due to damage to the aortic valve of the heart through the recommended scales, allowing for the screening of senile asthenia syndrome. Frailty syndrome (or senile asthenia) is characterized by a decrease in the body’s ability to recover from stress agents. Senile asthenia increases the body’s sensitivity to pathological factors, as it contributes to the development of multiple disorders in various organs and systems, reducing the body’s physiological reserves. Despite the fact that senile asthenia is by definition associated with advanced age, old age is not always accompanied by fragility, as the pathophysiology of senile asthenia syndrome is based on the dysregulation of the immune, endocrine, and metabolic systems of the body, which can occur among the middle-aged population.

The paper provides a clinical case of physical and medical rehabilitation of patient D born in 1963. Principal diagnosis established in 2018 according to ICD-10: I42.0 dilated cardiomyopathy. Laboratory testing revealed DNA of herpes virus 6 (HHV6), positive test for cytomegalovirus (CMV) DNA, 6.0×102 copies/mL, positive test for the Epstein–Barr virus (EBV) DNA, 7.2×103 copies/mL. In April 2018, the patient underwent successful surgery, implantation of the biventricular bypass system supplemented by membrane oxygenation. Physical rehabilitation was performed that yielded positive results.

Spectral analysis of heart rate variability gives an idea of the role of the autonomic nervous system in the regulation of chronotropic heart function and can be used to evaluate the effectiveness of drug therapy. The selection of drug therapy taking into account the individual clinical form of atrial fibrillation, as well as the vegetative status of the patient, will undoubtedly increase the effectiveness of treatment. In this study, spectral parameters were studied in patients with newly diagnosed atrial fibrillation and the effect of the antiarrhythmic drug class III miodarone on these parameters.

Background: Coronary heart disease (CHD) is considered as an independent risk factor for COVID19, however, the indicators of inflammation and endogenous intoxication in patients with CHD 3-4 weeks after recovery from COVID-19 have not been the subject of scientific research. The aim of the study: Assessment of the gerontological features of the effect of the transferred new coronavirus infection on the indicators of the interleukin profile, inflammation and endogenous intoxication of mature and elderly patients with coronary heart disease in the early stages of recovery. Materials and methods: The study included 58 mature-age patients with coronary heart disease 3-4 weeks after recovery from COVID-19 of moderate severity, who made up the comparison group. The main group of patients was represented by 62 elderly people with coronary heart disease who had suffered a new coronavirus infection and were examined in the same way as the previous group, 3-4 weeks after recovery. The level of C-reactive protein and highly sensitive C-reactive protein in the blood was studied using the Nicomed-reader express analyzer, and antistreptolysin-O was studied using an immunoturbidimetric method on the Cobas 600 analyzer (Switzerland). The blood levels of bilirubin, urea, creatinine and sialic acids were studied using the ROKI biochemical analyzer. The content of systemic cytokines was determined by the Beckton Dickinson FACS Canto 2 (USA). The level of anxiety and depression was studied on the HADS scale. Results: 3-4 weeks after recovery from COVID-19, antistreptolysin-O levels ranged from 120.9 МЕ/ml to 208.1 МЕ/ml. Significant changes among the considered parameters of inflammation and endogenous intoxication in patients with coronary heart disease in old age during recovery from a new coronavirus infection were accompanied by a change in the content of highly sensitive C-reactive protein in peripheral blood. In the early stages of recovery after COVID-19, in elderly patients with coronary heart disease, the concentration of many studied cytokines in blood plasma remained elevated compared with those aged 45-59 years. The excess of reference values in both groups was found for IL-17, TNF-α and IFN-α, and among elderly patients – for IL-3, IL-4, IL-6, IL-7, IL-17. Conclusion: Antistreptolysin-O, highly sensitive C-reactive protein, C-reactive protein can be considered markers of recovery in patients with combined coronary heart disease in the early stages after a new coronavirus infection.

Cardiovascular Diseases (CVD) have become the leading cause of death worldwide: for no other reason as many people die every year from CVD. This problem affects low and middle-income countries to varying degrees. More than 80% of deaths from CVD occur in these countries, almost equally among men and women, however, patients who survived after Myocardial Infarction (MI) are at high risk of death. According to the main facts of the WHO, 17.9 million people died from CVD in 2016, which accounted for 31% of all deaths in the world. In this connection, it is necessary to improve medical rehabilitation and physical rehabilitation, in particular for CVD, especially on an outpatient basis. Competent physical rehabilitation and cardiac rehabilitation in patients with myocardial infarction are associated with improved survival and effectiveness of quality of life, as well as prevention of recurrent MI. There is a legislative framework FZ-No. 323 of 21.11.2011 “On the basics of health protection of citizens in the Russian Federation” concerning medical rehabilitation and “Procedure for organizing medical rehabilitation” No. 1705n of 29.12.2012. This study shows physical rehabilitation methods of health path and Nordic walking. Terrenkur is a method of sanatorium-and-spa treatment, which provides for dosed physical activity in the form of walking tours (5 km - 6 km daily at 12.00 - 13.00). Nordic walking - walking with sticks, a type of physical activity that uses a certain training methodology and walking technique with the help of specially designed sticks (5 km - 6 km daily at 12.00 - 13.00). Multiple meta-analyses showed that Cardiovascular Rehabilitation (CVR) reduces mortality in patients with coronary artery disease. Despite the recommendations and recommendations for the use of programs for patients with previous MI, patient participation in these programs remains low, which has led to the development of alternative models of medical rehabilitation.

The postgraduate education of doctors in the principles of rational pharmacotherapy, conducted on the educational program «Polypragmasia in a therapeutic and preventive organization: a problem and a solution» of 36 academic hours, allowed to reduce the total number of simultaneously prescribed medications in elderly patients of a cardiological profile in a gerontological hospital (the number of medications received by patients older than 75 years before and after training, respectively 9.48±2.6 vs 7.12±1.9, p<0.001). A decrease in polypragmasia contributed to a decrease in the frequency of suspected unforeseen serious adverse reactions, which included falls associated with taking medications. The simultaneous introduction of Safety Protocols, Standard Operating Procedures for identifying patients at high risk of falling and conducting incident analysis led to the analysis of each case of an elderly and senile patient falling in a hospital and a review of the treatment received.

Cardiovascular diseases (hereinafter - CVD) have become the leading cause of death worldwide: for no other reason as many people die every year as from CVD. This problem affects low and middle income countries to varying degrees. More than 80% of deaths from CVD occur in these countries, almost equally among men and women, however, patients who survived after myocardial infarction (hereinafter - MI) are at high risk of death. According to the main facts of the WHO, 17.9 million people died from CVD in 2016, which accounted for 31% of all deaths in the world. In this connection, it is necessary to improve medical rehabilitation (hereinafter - MR), in particular for CVD, especially on an outpatient basis. Competent MR, cardiac rehabilitation in patients with myocardial infarction is associated with improved survival and effectiveness of quality of life, as well as prevention of recurrent MI. There is a legislative framework FZ-No. 323 of 21.11.2011 "On the basics of health protection of citizens in the Russian Federation" concerning medical rehabilitation and "Procedure for organizing medical rehabilitation" No. 1705n of 29.12.2012. Multiple meta-analysis showed that cardiovascular rehabilitation (hereinafter - CVR) reduces mortality in patients with coronary artery disease. Despite the recommendations and recommending the use of programs for patients with previous MI, patient participation in these programs remains low, which has led to the development of alternative models of medical rehabilitation.