Vladimir I. Gridnev

Objective: To develop a system of quality measures for monitoring the process and outcome of medical care in patients with chronic heart failure (CHF) in real clinical practice. Review methodology. The procedure for selecting indicators to monitor the treatment of cardiological patients proposed by О M. Posnenkova (2013) was applied. An analysis of the Russian Ministry of Health's clinical guidelines on CHF (2024) was conducted to determine the characteristics of the planned treatment outcomes and key measures with proven impact on outcomes. A systematic literature review using the PRISMA methodology was performed to identify therapeutic interventions that determine the achievement of results in real-world clinical practice. The PubMed and eLibrary databases were used. The search depth was from 2020 to 2024. Twenty-five sources were selected. Conclusion. In real clinical practice it is advisable to assess: 1) the proportion of patients with HF with reduced ejection fraction (EF) who have been prescribed quad-riple therapy (angiotensin-converting enzyme inhibitor/angiotensin receptor/angiotensin receptor neprilysin inhibitors + beta-blockers + aldosterone receptor antagonists + sodium/glucose cotransporter 2 inhibitors); 2) the proportion of patients with HF with preserved EF and HF with mildly reduced EF who have been prescribed sodium/glucose cotransporter 2 inhibitors; 3) the proportion of HF patients without adverse events (hospitalizations due to HF or death) over the past 12 months.

Objective—Heart rate variability (HRV) and photoplethysmographic waveform variability (PPGV) are available approaches for assessing the state of cardiovascular autonomic regulation. The goal of our study was to compare the frequency-domain features and low-frequency (LF) synchronization of the PPGV and HRV with increasing severity of cardiovascular diseases. Methods—Our study included 998 electrocardiogram (ECG) and finger photoplethysmogram (PPG) recordings from subjects, classified into five categories: 53 recordings from healthy subjects, aged 28.1 ± 6.2 years, 536 recordings from patients with hypertension (HTN), 49.0 ± 8.8 years old, 185 recordings from individuals with stable coronary artery disease (CAD) (63.9 ± 9.3 years old), 104 recordings from patients with myocardial infarction (MI) that occurred three months prior to the recordings (PMI) (65.1 ± 11.0 years old), and 120 recordings from study subjects with acute myocardial infarction (AMI) (64.7 ± 11.5 years old). Spectral analyses of the HRV and PPGV were carried out, along with an assessment of the synchronization strength between LF oscillations of the HRV and of PPGV (synchronization index). Results—Changes in all frequency-domain indices and the synchronization index were observed along the following gradient: healthy subjects → patients with HTN → patients with CAD → patients with PMI → patients with AMI. Similar frequency-domain indices of the PPGV and HRV show little relationship with each other. Conclusions—The frequency-domain indices of the PPGV are highly sensitive to the development of any cardiovascular disease and, therefore, are superior to the HRV indices in this regard. The S index is an independent parameter from the frequency-domain indices.

INTRODUCTION. The implementation of remote cardiac rehabilitation (RCR) technology based on telemedicine platforms (TMP) requires a preliminary assessment of the feasibility of use. AIM. A preliminary study of the feasibility of using the integrated TMP “IS-cardio” to perform RCR in patients with cardiovascular diseases (CVD) in the context of need, feasibility and acceptability. MATERIALS AND METHODS. Single-center cohort study of patients (n = 33; 75 % men; mean age 56 ± 8 years) with CVD. Testing of the TMP «IS-cardio» was carried out during 12-week physical training (PT) programs with an intensity of 55 %. Feasibility was assessed according to the following criteria: need, feasibility, acceptability. Data on need and acceptability were obtained from a patient survey. Feasibility was assessed as the proportion of patients completing RCR. Remote monitoring was performed using heart rate, blood pressure, electrocardiogram and mobile application recorders. Feedback was provided in the form of electronic reports and delayed consultation. Patient satisfaction was assessed in points. RESULTS. 79.2 % of respondents were interested in telemedicine monitoring. 100 % of patients completed RCR; 12 patients (39.6 %) fully completed the PT program. The patients’ activity amounted to 2.4 ± 0.7 PT sessions per week; the average duration of PT was 56.5 ± 29.8 min/week. With a total satisfaction of 29.0 ± 3 points, the level of RCR was highly rated (3.85 ± 0.16 points) as a real solution to the problem associated with the presence of CVD (3.67 ± 0.34 points). DISCUSSION. The medical-technological solution TMP “IS-cardio”, combining the principles of traditional cardiac rehabilitation with telecardiology tools (monitoring based on digital recorders, automatic data transfer and feedback) met the criteria for the feasibility of using TMP with a similar concept. CONCLUSION. The high demand for remote monitoring, feasibility, and patient satisfaction of RCR may indicate the feasibility of its use for implementation of its programs.

Introduction — Identifying critical endpoints during long-term follow-up of patients with coronary artery disease (CAD) and anemia after percutaneous coronary intervention (PCI) would allow optimizing management tactics for this group of patients. Objective — To investigate the risks of developing adverse cardiovascular complications in patients with anemia who underwent revascularization for acute coronary syndrome (ACS) and to assess the most significant factors affecting outcomes. Material and Methods — The study included 298 patients with CAD who had undergone PCI at least two years before enrollment. A survey of patients and a retrospective analysis of their medical records were conducted. The outcome was a composite endpoint (death, myocardial infarction, stroke, transient ischemic attack). Kaplan-Meier curves were constructed to assess the effect of anemia on outcomes. To identify predictors of an adverse outcome, a Cox regression model was built. Results — In the group of patients with ACS who underwent PCI, the incidence of anemia was 8.4%. The incidence of the composite endpoint in patients with anemia was 51.6%, which was significantly different from its value in patients without anemia after 400 days of follow-up (logrank test, p<0.008). After day 1,200, both groups exhibited similar dynamics of adverse outcomes. The following factors were statistically significantly linked to the risk of death within 24 months after PCI: left ventricular ejection fraction (p=0.002), anemia (p=0.009), and chronic kidney disease (p=0.02). Conclusion — We demonstrated that anemia influenced the development of adverse outcomes from day 400 to day 1,200 of a follow-up. Some factors, such as left ventricular ejection fraction and the presence of chronic kidney disease, also had a high predictive power for adverse events.

The objective of the study was to analyze the contribution of the Department of Propaedeutics of Internal Diseases at Saratov State Medical University to practical healthcare, depending on the historical context of its work. Articles contained in the eLibrary and CyberLeninka databases, as well as data from open Internet sources about the history of the department, were analyzed. The obtained data are compared with the historical events of the corresponding period. It was shown that mutually beneficial cooperation between the clinic, the department and the research institute seem to be a reliable and economical form of introducing new medical care technologies into practical healthcare.

Irregularity is an important aspect of the cardiovascular system dynamics. Numerical indices of irregularity, such as the largest Lyapunov exponent and the correlation dimension estimated from interbeat interval time series, are early markers of cardiovascular diseases. However, there is no consensus on the origin of irregularity in the cardiovascular system. A common hypothesis suggests the importance of nonlinear bidirectional coupling between the cardiovascular system and the respiratory system for irregularity. Experimental investigations of this theory are severely limited by the capabilities of modern medical equipment and the nonstationarity of real biological systems. Therefore, we studied this problem using a mathematical model of the coupled cardiovascular system and respiratory system. We estimated and compared the numerical indices of complexity for a model simulating the cardiovascular dynamics in healthy subjects and a model with blocked regulation of the respiratory frequency and amplitude, which disturbs the coupling between the studied systems.