Cardiovascular Disease In Russia Research Articles

Priority directions of occupational medicine development in Perm Krai: challenges and realities

Objective. To analyze the priority directions of the development of occupational medicine in Perm Region.
 Materials and methods. Statistical data on morbidity and mortality from cardiovascular diseases in Russia, obtained from the Central Statistical Database of the Federal State Statistics Service, were analyzed. A literature review was performed.
 Results. Priority areas of occupational medicine in Perm Region are the following: preservation of workers' health, improvement of occupational medicine based on corporate health improvement programs. An important aspect is the assessment of specific working conditions, the identification of risk groups for the development of production-related and occupational diseases.
 Conclusions. It is necessary to take into account early signs of comorbidity of age-associated diseases, introduction of health-saving technologies and development of corporate programs.

Modern age-specific pattern of mortality from cardiovascular diseases and its Moscow-specific features

Background. Mortality from acute cardio-vascular diseases (CVD) remain a global challenge. Age-specific profiles of chronic and acute CVD deaths remain topical: is there any principal difference between the two?
 The purpose of the study is to analyze age-specific profiles of acute and chronic CVD deaths in Russia and identify Moscow-specific features.
 Material and methods. The study analyzed Rosstat data on mortality from leading CVD in Russia and Moscow in 2019.
 Results. The internal structure of acute CVD is characterized by age-specific vectors, more pronounced in Russia. Myocardial infraction makes the highest contribution accounting for 27.9% and 26.1% in ages of 70–74 years. The share of other acute IHD is over 20% in males and 15% in females under 60, increasing with age. Mortality from stroke unsurprisingly increases with age with the maximum of about ⅔ over senile ages.
 Sudden cardiac deaths are rather high among the Russian youth, while in Moscow they remain minimum throughout all ages.
 Limitations. An analysis was made of data on mortality from major cardiovascular pathologies in Russia and Moscow only in 2019.
 Conclusion. Age-specific profile of chronic and acute CVD are characterized by similar patterns: increase in age-specific indicators with the maximum in senile ages.
 Age profile of the Moscow mortality is characterized by high mortality from unspecified cardiomyopathy, many-fold exceeding the Russian indicator.
 Acute cardiac deaths require a further analysis to identify nosological criteria to evaluate death rates.

The Federal Project "Fighting Cardiovascular Diseases": Dynamics of quantitative indices during the COVID-19 pandemic

Aim to analyze the dynamics of indicators of the Federal Project "Fighting Cardiovascular Diseases" and to suggest improving the project management methods in healthcare.
 Material and methods. The data was collected from Federal statistical observation form No. 14 "Data on activity of divisions of the medical organizations providing in-hospital medical care", form No. 30 "Data on the medical organization". The target indicators were selected from the Passport of Federal Project "Fighting Cardiovascular Diseases". The data on mortality rate was collected from the Rosstat reports on the number of population and the number of deaths by different diseases.
 Results. In Russia, the frequency of endovascular interventions in acute coronary syndrome is growing essentially exceeding the target values of the Federal Project. Several regions are leading in the intensity of performing these operations (taking into account the population size) leaving behind many developed countries. At the same time, the death rate from cardiovascular diseases in Russia remains one of the highest in the world. The problem of medical care quality is still acute. The in-hospital lethality rates from cerebrovascular accident and acute myocardial infarction have significantly exceeded the target values during the entire period of observation.
 Conclusion. During the infectious pandemics, the actions and target indicators of federal projects in healthcare should be revised. The healthcare model focusing on disease prevention, conservative treatment and telemedicine is preferable.

Features of the management of coronary heart disease in patients with metabolically associated fatty liver disease

Among chronic non-communicable diseases, which make a significant contribution to mortality rates in the developed countries of the world, the leading positions are occupied by diseases of the circulatory system. According to statistics, one million people a year die from cardiovascular diseases in Russia. In an extensive nosological group of diseases of the circulatory system, coronary heart disease is the main cause of death and disability in the adult population. The annual mortality from coronary heart disease among the population of Russia is 27 %. To date, the number of patients with coronary heart disease with comorbid pathology, especially with diseases of the hepatobiliary system, metabolic syndrome, is increasing. The prevalence of metabolically associated fatty liver disease is 20 to 30 % in the population and tends to increase. The combined course of metabolically associated fatty liver disease and coronary heart disease occurs in 14-18 % of cases. Objective: to determine the impact of metabolically associated fatty liver disease on the course of coronary heart disease and the possibility of correcting metabolic disorders to prevent the development of cardiovascular complications. Materials and methods. 35 patients with coronary heart disease and metabolically associated fatty liver disease were examined; they were noted to have more severe clinical course of stenocardia and higher risk of cardiovascular complications, then those patients without liver diseases. Results and its discussion. It was estimated, that using thiotriazoline and ursodeoxycholic acid in addition to standard medicamentous therapy improves clinical course of stenocardia as well as overall quality of life due to high antianginal and antioxidant effects. Conclusions. Hepatoprotective therapy increases possibility of correction of metabolic defects, dyslipidemia, decreases the risk of oxidative stress, prevents development of life threatening cardiovascular conditions and can be used to optimize treatment of comorbid patients.

Awareness and readiness to combat risk factors for cardiovascular disease: results of a survey of patients and doctors using open questions

Relevance. Assessment of the cardiovascular risk factors (RF) knowledge is important for the development of disease preventive programs. It is shown that awareness of the RF does not guarantee readiness for their correction, and there is a potential gap between intention and behavior. Ample evidence suggests that a physician’s commitment to a healthier lifestyle and RF control increases patient confi in his recommendations. Assessment of the subjective attitude to RF for the development of cardiovascular diseases (CVD) and the readiness for their correction not only in patients, but also in doctors is an important task both for the health of the doctors themselves and indirectly for their future and current patients.Objective. To assess the subjective attitude to RF for the development of CVD and the readiness for their correction in doctors and patients of one medical organization.Design and methods. The study included 58 doctors and 55 patients who were consecutively hospitalized in different departments of the Medical Research and Education Center of Moscow State University named after M. V. Lomonosov. Doctors and patients of the cardiology department were not included in the study. All questions about CVD RF were open. The number of answers was not limited.Results. The analysis included 58 questionnaires of doctors and 52 questionnaires of patients. The median age of physicians was 37 [31; 48] years, among them 40 % were men. The median age of patients was 61 [49; 71] years, men — 42 %. Physicians expectedly showed higher awareness of various RF for CVD. They called an average of 4,9 ± 2,0 RF, and patients — 3,9 ± 1,6, but the difference was not significant. Physicians were more aware of carbohydrate metabolism disorders, malnutrition, physical inactivity, sleep disturbances, and stress as CVD RF (all p < 0,001), with more frequent patients, than physicians indicated smoking (67,3 % and 27,6 %, respectively, p < 0,001). Female physicians were statistically significantly less likely to report obesity (4,3 % and 25,7 %, respectively, p = 0,013). At the same time, they indicated hypertension more often than men (13,0 % and 2,6 %, respectively, p = 0,018). Physicians named one RF that threatened their own health more (p < 0,001). At the same time, physicians were willing to try to change less than half of these factors, while inpatients were determined to change two-thirds of the factors (45,9 % and 66,1 %, p = 0,012). Conclusions. The level of physicians’ awareness of CVD RF and readiness for change remains relatively low. To combat the growing burden of CVD in Russia, it is necessary to maximize the potential of not only cardiologists, but also doctors of other specialties, as channels of reliable information about health, develop and implement measures to increase awareness of the circumstances that contribute to the development of CVD, as well as tools for self-management of risks, not only among patients, but also among medical workers.

On the issue of the prevalence of diseases of the circulatory system in the adult population and prevention measures in Russia (review)

The problem of the prevalence of cardiovascular diseases in the Russian Federation is widespread, since diseases of the circulatory system occupy the first place in the overall structure of morbidity. The purpose of this study is to analyze the current situation in the Russian Federation with the prevalence of cardiovascular diseases and the implementation of appropriate preventive measures at the Federal and regional levels. In the course of this study, a retrospective analysis was carried out based on the use of official statistics of the Ministry of health. Trends in the overall morbidity and mortality of BSC in the adult population in the Russian Federation at the regional level are determined. Statistical data processing was carried out using SPSS and Excel-2007 packages. Thus, analytical and statistical methods, studying and generalizing experience, and comparative analysis were used. The study analyzed the dynamics of the spread of diseases of the circulatory system in Russia, identified regional features of morbidity and mortality, and identified the main preventive measures carried out in the fight against cardiovascular diseases, and their problematic aspects. In the result of the analysis it can be concluded that the observed trends may be the result not only of low availability of medical care in some constituent entities of the Russian Federation, as a result of the influence in the modern world a huge number of factors, so to improve the situation of prevalence of cardiovascular diseases in Russia it is necessary to take preventive measures for the reorientation of society on the formation of motivational attitudes to healthy lifestyles, strengthening the role zdoroveuchenye activities and develop additional programs at the municipal level, which will reduce morbidity and mortality from BSC through the introduction of an interdisciplinary approach.

Obesity prevalence and associations with socio-economic and behavioral factors in population-based studies in Russia and Norway, 2015–2017

Abstract Background Obesity is an epidemic of XXI century, as its prevalence doubled during the last forty years. As Russia and Norway are countries with different life expectancy there could be differences in obesity and its correlates. Purpose To investigate and compare prevalence and socio-economic and behavioral factors associated with obesity in Russia and Norway with data from population-based studies. Methods We used multivariable logistic regression to examine associations of obesity (body mass index>30 kg/m2) with socio-economic factors (age, education, marital status, and poor financial situation defined as difficulty to afford clothes) and behavioral characteristics (smoking, alcohol use) in participants aged 40–69 years from the Know Your Heart study (Russia, 2015–2017, N=4 106) and the seventh Study (Norway, 2015–16, N=17 604). All results for covariates are mutually adjusted. Between-study comparisons of the associations of obesity with the same covariates were performed through investigation of their interactions with the “study” variable. Results The age-standardized prevalence of obesity was higher in Russia among women (36.8 vs 22.0%, p<0.001) and did not differ among men (26.7 vs 25.7%, p=0.224). In Russian women, obesity was positively associated with age of 50–69 years relative to 40–49 years (OR=2.5, 95% CI 2.0–3.1), no university education (OR=1.5, 95% CI 1.2–1.8), and poor financial situation (OR=1.5, 95% CI 1.2–1.9). In Norwegian women, obesity was negatively associated with the age of 50–69 years (OR=0.8, 95% CI 0.8–1.0), current smoking (OR=0.8, 95% CI 0.7–1.0) and drinking alcohol ≥2 times per week (OR=0.6, 95% CI 0.5–0.6), and positively associated with no university education (OR=1.5, 95% CI 1.3–1.7), previous smoking (OR=1.3, 95% CI 1.1–1.4), and drinking ≥5 alcohol drinks per occasion (OR=1.7, 95% CI 1.3–2.2). In Russian men, obesity was positively associated with living with spouse/partner (OR=1.5, 95% CI 1.1–2.2), drinking alcohol ≥2 times per week (OR=1.4, 95% CI 1.1–1.8), and negatively associated with current smoking (OR=0.6, 95% CI 0.4–0.8). In Norwegian men, obesity was positively associated with no university education (OR=1.4, 95% CI 1.2–1.6), previous smoking (OR=1.3, 95% CI 1.2–1.5), and drinking ≥5 alcohol drinks per occasion (OR=1.7, 95% CI 1.5–1.9), and negatively associated with current smoking (OR=0.8, 95% CI 0.7–1.0) and drinking alcohol ≥2 times per week (OR=0.7, 95% CI 0.6–0.7). Interactions with the “study” variable in women were significant for age, financial situation, frequency of alcohol use; in men - for living with spouse/partner, frequency of alcohol use, number of alcohol drinks taken per occasion. Conclusion The prevalence of obesity was higher in Russian compared to Norwegian women, but there was no difference between Russian and Norwegian men. There were different between-country patterns of the associations of obesity with the socio-economic and behavioral characteristics. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The Know Your Heart study was a component of International Project on Cardiovascular Disease in Russia and funded by Wellcome Trust Strategic Award [100217], UiT The Arctic University of Norway, Norwegian Institute of Public Health, and Norwegian Ministry of Health and Care Services. The Tromsø Study was funded by UiT The Arctic University of Norway, Northern Norway Regional Health Authority, Norwegian Ministry of Health and Care Services, Norwegian Research Council, and various public and charity research funds in Norway. PhD scholarship and operational funds of the first author were provided by Northern State Medical University, Arkhangelsk, Russia and by UiT The Arctic University of Norway

Counselling on smoking cessation in primary care from the population perspective in two regions of the Russian Federation

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): This study was conducted as part of the International Project on Cardiovascular Disease in Russia (IPCDR). IPCDR is supported by the Wellcome Trust [100217/Z/12]; the Norwegian Ministry of Health; the Norwegian Institute of Public Health; UiT, The Arctic University of Norway. Background. Smoking is one of the main risk factors for noncommunicable disease, which account for about 71% of the world"s population mortality. The prevalence of smoking in Russia is 27.3% totally and average 37% in males. One of the effective strategies smoking cessation is counselling in primary care facilities. Purpose. Identify the frequency of counseling on smoking cessation in primary care from the population perspective in two regions of Russia and determine the socio-economic and behavioural factors associated with receiving advice on smoking. Methods. The study was carried out within the framework of the international scientific project "Know your heart" (2015-2018). A representative sample of residents of Novosibirsk and Arkhangelsk aged 35 to 69 years was included in the study. The frequency of getting advice on smoking cessation was analyzed among those respondents who have contacts with the healthcare system over the last year (n = 3320) and among those who are currently smokers (n = 738). Data were analyzed using SPSS v.17 and Jamovi v.1.6.8. Factors associated with the chance of getting were analyzed by binomial logistic regression analysis. The reliability of regression model was assessed using ROC analysis. Results. Only 491 responders (66.5%) who smoked and visited primary care facilities received advice on smoking cessation. Females were significantly less likely to receive counselling compared with males (Odds Ratio (OR) = 0.41; 95% Confidence Interval (CI) 0.27-0.60; p˂0.001), people aged 65+ compared with age group 35-44 (OR = 0.37; 95% CI 0.16-0.82; p = 0.014), working persons compared with pensioners (OR = 0.58; 95% CI 0.35-0.98; p = 0.041). Obesity (BMI = 30.0-34.9) significantly increased the chance of getting advice on smoking cessation compared with normal body mass (OR = 2.05; 95% CI 1.19-3.52; p = 0.010), as well as visits the GP (for visiting GP 1-2 times a year: OR = 1.66; 95% CI 1.12-2.46; p = 0.011; for visiting GP 3-4 times a year: OR = 3.35; 95% CI 1.76-6.36; p˂0.001; for visiting GP≥5 times a year: OR = 2.94; 95% CI 1.41-6.13; p = 0.004). Other types of contacts with healthcare system included in the analysis (visits to other specialists, hospitalizations, ambulance calls during previous 12 months) were not associated with the chance of getting advice on smoking quitting. The accuracy of the obtained regression model was 62.13 (p˂0.001). ROC analysis showed that the sensitivity of the model is 89.2%, specificity is 31.6%, the area under the ROC curve (AUC) is 0.710 ± 0.020 (95% CI 0.67-0.75) that corresponds to the good quality of the model. Conclusion. The healthcare system needs to be more proactive in conducting counseling on smoking cessation. Gender, age, BMI, visit to a GP were associated with receiving counseling on smoking cessation. More attention should be paid to women, elderly people and men with normal BMI. Other specialists except GPs also should pay attention to the patients smoking habits and give advice. Abstract Figure. ROC curve

Endothelial dysfunction as early predictor of atherosclerosis

Cardiovascular diseases in Russia are leading in the structure of total mortality. Atherosclerosis is considered a progressive inflammatory systemic disease. The role of endothelium in the development of the atherosclerotic process is described in detail. The main functions of endotheliocytes are normal and in various pathological conditions. The main markers of endothelial dysfunction are presented. Data on the development of the atherosclerotic process in time, risk factors are presented. Local and systemic risk factors for atherosclerosis are highlighted. Own data on the frequency of occurrence of atherosclerotic changes in the main vessels of the head in young people (up to 45 years) based on the results of ultrasonic duplex scanning during professional examinations are presented. The main directions of correction of endothelial dysfunction are described.

Heart failure. The current state of the problem: achievements, frustrations, hopes and prospects

The article presents overview and statistical data on heart failure and cardiovascular diseases in Russia, world research data on various forms of heart failure in accordance with the modern classification, their clinical, anamnestic and prognostic differences, different approaches to the treatment of heart failure , discussion the prospects of this direction in cardiology, including the relevance of medical technology assessment.

Patterns in the relationship between life expectancy and gross domestic product in Russia in 2005–15: a cross-sectional analysis

SummaryBackgroundSince 2005, Russia has made substantial progress, experiencing an almost doubling of per-capita gross domestic product by purchasing power parity (GDP [PPP]) to US$24 800 and witnessing a 6-year increase in life expectancy, reaching 71·4 years by 2015. Even greater gains in GDP (PPP) were seen for Moscow, the Russian capital, reaching $43 000 in 2015 and with a life expectancy of 75·5 years. We aimed to investigate whether mortality levels now seen in Russia are consistent with what would be expected given this new level of per-capita wealth.MethodsWe used per-capita GDP (PPP) and life expectancy from 61 countries in 2014–15, plus those of Russia as a whole and its capital Moscow, to construct a Preston curve expressing the relationship between mortality and national wealth and to examine the positions of Russia and other populations relative to this curve. We adjusted life expectancy values for Moscow for underestimation of mortality at older ages. For comparison, we constructed another Preston curve based on the same set of countries for the year 2005. We used the stepwise replacement algorithm to decompose mortality differences between Russia or Moscow and comparator countries with similar incomes into age and cause-of-death components.FindingsLife expectancy in 2015 for both Russia and Moscow lay below the Preston-curve-based expectations by 6·5 years and 4·9 years, respectively. In 2015, Russia had a lower per-capita income than 36 of the comparator countries but lower life expectancy than 60 comparator countries. However, the gaps between the observed and the Preston-expected life expectancy values for Russia have diminished by about 25% since 2005, when the life expectancy gap was 8·9 years for Russia and 6·6 years for Moscow. When compared with countries with similar level of income, the largest part of the life expectancy deficit was produced by working-age mortality from external causes for Russia and cardiovascular disease at older ages for Moscow.InterpretationGiven the economic wealth of Russia, its life expectancy could be substantially higher. Sustaining the progress seen over the past decade depends on the ability of the Russian Government and society to devote adequate resources to people's health.FundingThis work was partly funded through the International Project on Cardiovascular Disease in Russia supported by a Wellcome Trust Strategic Award (100217) and was supported by the Russian Academic Excellence Project 5-100.

Know Your Heart: Rationale, design and conduct of a cross-sectional study of cardiovascular structure, function and risk factors in 4500 men and women aged 35-69 years from two Russian cities, 2015-18.

Russia has one of the highest rates of cardiovascular disease in the world. The International Project on Cardiovascular Disease in Russia (IPCDR) was set up to understand the reasons for this. A substantial component of this study was the Know Your Heart Study devoted to characterising the nature and causes of cardiovascular disease in Russia by conducting large cross-sectional surveys in two Russian cities Novosibirsk and Arkhangelsk. The study population was 4542 men and women aged 35-69 years recruited from the general population. Fieldwork took place between 2015-18. There were two study components: 1) a baseline interview to collect information on socio-demographic characteristics and cardiovascular risk factors, usually conducted at home, and 2) a comprehensive health check at a primary care clinic which included detailed examination of the cardiovascular system. In this paper we describe in detail the rationale for, design and conduct of these studies.

10.K. Workshop: Cardiovascular Disease in Russia: Insights from a new international project

10.K. Workshop: Cardiovascular Disease in Russia: Insights from a new international project

10.K. Workshop: Cardiovascular Disease in Russia: Insights from a new international project

10.K. Workshop: Cardiovascular Disease in Russia: Insights from a new international project

Know Your Heart: Rationale, design and conduct of a cross-sectional study of cardiovascular structure, function and risk factors in 4500 men and women aged 35-69 years from two Russian cities, 2015-18.

Russia has one of the highest rates of cardiovascular disease in the world. The International Project on Cardiovascular Disease in Russia (IPCDR) was set up to understand the reasons for this. A substantial component of this study was the Know Your Heart Study devoted to characterising the nature and causes of cardiovascular disease in Russia by conducting large cross-sectional surveys in two Russian cities Novosibirsk and Arkhangelsk. The study population was 4542 men and women aged 35-69 years recruited from the general population. Fieldwork took place between 2015-18. There were two study components: 1) a baseline interview to collect information on socio-demographic characteristics and cardiovascular risk factors, usually conducted at home, and 2) a comprehensive health check at a primary care clinic which included detailed examination of the cardiovascular system. In this paper we describe in detail the rationale for, design and conduct of these studies.

Know Your Heart: Rationale, design and conduct of a cross-sectional study of cardiovascular structure, function and risk factors in 4500 men and women aged 35-69 years from two Russian cities, 2015-18

Russia has one of the highest rates of cardiovascular disease in the world. The International Project on Cardiovascular Disease in Russia (IPCDR) was set up to understand the reasons for this. A substantial component of this study was the Know Your Heart Study devoted to characterising the nature and causes of cardiovascular disease in Russia by conducting large cross-sectional surveys in two Russian cities Novosibirsk and Arkhangelsk. The study population was 4542 men and women aged 35-69 years recruited from the general population. Fieldwork took place between 2015-18. There were two study components: 1) a baseline interview to collect information on socio-demographic characteristics and cardiovascular risk factors, usually conducted at home, and 2) a comprehensive health check at a primary care clinic which included detailed examination of the cardiovascular system. In this paper we describe in detail the rationale for, design and conduct of these studies.

Know Your Heart: Rationale, design and conduct of a cross-sectional study of cardiovascular structure, function and risk factors in 4500 men and women aged 35-69 years from two Russian cities, 2015-18

Russia has one of the highest rates of cardiovascular disease in the world. The International Project on Cardiovascular Disease in Russia (IPCDR) was set up to understand the reasons for this. A substantial component of this study was the Know Your Heart Study devoted to characterising the nature and causes of cardiovascular disease in Russia by conducting large cross-sectional surveys in two Russian cities Novosibirsk and Arkhangelsk. The study population was 4542 men and women aged 35-69 years recruited from the general population. Fieldwork took place between 2015-18. There were two study components: 1) a baseline interview to collect information on socio-demographic characteristics and cardiovascular risk factors, usually conducted at home, and 2) a comprehensive health check at a primary care clinic which included detailed examination of the cardiovascular system. In this paper we describe in detail the rationale for, design and conduct of these studies.

New data on the use of rosuvastatin and acetylsalicyl acid for the prolongation of human life

This review deals with the necessary and relevant measures for primary and secondary prevention of cardiovascular diseases in Russia. The latest European and American guidelines emphasize that statins are the main class of drugs to be used to improve prognosis. The use of rosuvastatin is justified among the categories of moderate and high risk of developing cardiovascular complications, especially in severe hypercholesterolemia. The use of acetylsalicylic acid is undoubtedly useful for the secondary and, which is more controversial, for the primary prevention of cardiovascular diseases. Over the last few years, major clinical studies on the prevention of cardiovascular, hemorrhagic and oncological complications enable to rely on the expediency of combined, safe use of rosuvastatin and acetylsalicylic acid in individuals over 50 years of age with moderate and high cardiovascular risk. The use of both drugs in one tablet (the original drug Rosulip ASA®, EGIS Pharmaceuticals PLC, Hungary) will significantly increase the compliance with the vital therapy and significantly expand the use of rosuvastatin in clinical practice, which means further reduction in morbidity and mortality from atherosclerotic cardiovascular diseases.

The management of acute myocardial infarction in the Russian Federation: protocol for a study of patient pathways

Death rates from cardiovascular disease in Russia are among the highest in the world. In recent years, the Russian government has invested substantially in the healthcare system, with a particular focus on improving access to advanced technology, especially for acute myocardial infarction (AMI). This protocol describes a study to understand the management of AMI in different Russian regions, investigating the role of patient, clinical, and health system characteristics. A prospective observational study has recruited a representative sample of AMI patients from 16 hospitals in 13 regions across Russia. Criteria for inclusion are being aged 35-70 years with a confirmed diagnosis of AMI and surviving until the day after admission. Information being collected includes health system contacts and features of clinical management prior to the event and in the 12 months following discharge from hospital. Following initial exploration of the data to generate hypotheses, multilevel modelling will be applied to assess the role of these characteristics in both treatment decisions and any delays in time critical interventions. Between June 2015 and August 2016, 1,122 patients have been recruited at baseline and follow-up to 12 months post-discharge is scheduled to be completed by autumn 2017. The study is unique in examining patient factors, clinical management prior to admission and in hospital in the acute phase and throughout the critical first year of recovery across a diverse range of geographies and facilities. It uses standardized instruments to collect data from patients and health care providers and includes regions that are diverse in terms of geography and development of cardiology capacity. However, given the limited health services research capacity in the Russian Federation, it was not possible to obtain a sample that was truly nationally representative.

The management of acute myocardial infarction in the Russian Federation: protocol for a study of patient pathways

Background: Death rates from cardiovascular disease in Russia are among the highest in the world. In recent years, the Russian government has invested substantially in the healthcare system, with a particular focus on improving access to advanced technology, especially for acute myocardial infarction (AMI). This protocol describes a study to understand the management of AMI in different Russian regions, investigating the role of patient, clinical, and health system characteristics. Methods: A prospective observational study has recruited a representative sample of AMI patients within 16 hospitals from 13 regions across Russia. Criteria for inclusion are being aged 35-70 years with a confirmed diagnosis of AMI and surviving until the day after admission. Information being collected includes health system contacts and features of clinical management prior to the event and in the 12 months following discharge from hospital. Following initial exploration of the data to generate hypotheses, multivariate analyses will be applied to assess the role of these characteristics in both treatment decisions and any delays in time critical interventions. Between June 2015 and August 2016, 1,122 patients have been recruited at baseline and follow-up to 12 months post-discharge is scheduled to be completed by autumn 2017. The study is unique in examining patient factors, clinical management prior to admission and in hospital in the acute phase and throughout the critical first year of recovery across a diverse range of geographies and facilities. It uses standardized instruments to collect data from patients and health care providers and includes regions that are diverse in terms of geography and development of cardiology capacity. However, given the limited health services research capacity in the Russian Federation, it was not possible to obtain a sample that was truly nationally representative.