Purpose of the study. Based on an analysis of the medical and demographic situation and the incidence of acute coronary syndrome in the Russian Federation, in the federal districts and constituent entities of the Russian Federation, as well as in the pilot territory of the Republic of Bashkortostan, proposals are given for the development of management decisions at the regional and federal levels. Materials and methods: statistical, analytical. We used statistical materials of the Federal State Statistics Service (2014–2021), statistical materials: M., TsNIIOIZ of the Ministry of Health of the Russian Federation (2023) and the Republic of Bashkortostan MIAC, Ufa (2022). Results. The leading cause of mortality in the Republic of Belarus, as well as in the Russian Federation as a whole, is diseases of the circulatory system (CVD). In 2022, the mortality rate of the population from CVD in the Republic of Belarus was 459,5 per 100 thousand population, in the Russian Federation the figure was higher – 560,8‰oo. Fluctuations in indicators in the constituent entities of the Russian Federation are 7,6 times. The primary morbidity rate of the adult population in the Republic of Bashkortostan was BSK (2022) 4948,6‰oo. Acute coronary syndrome (ACS) is a group of clinical symptoms or signs suggestive of acute myocardial infarction (MI) or unstable angina (UA). The primary incidence rate of the adult population of the Republic of Belarus with unstable angina pectoris was (2022) 113,8‰oo, acute myocardial infarction – 97,7‰oo, in the Russian Federation the figures are higher – 106,7 and 140,8‰oo, respectively. The difference in the incidence of myocardial infarction among the adult population in the constituent entities of the Russian Federation is 9,3 times; the difference in unstable angina is huge – 54 times, which to a certain extent indicates the ambiguity of the coding of unstable angina. The study indicates the need for an in-depth analysis of the incidence of acute coronary syndrome in the constituent entities of the Russian Federation. Conclusions. It is necessary to develop management decisions, including improving the accessibility and quality of cardiac care to thepopulation, including patients with acute coronary syndrome, at the regional and federal levels.