Vol 22, No 5 (2020)
Articles
Management of treatment on the basis of adherence
Abstract
Consensus Document "Management of treatment on the basis of adherence" developed by Russian Scientific Medical Society of Internal Medicine along based on clinical guidelines of Russian Scientific Medical Society of Internal Medicine approved the XIV National Congress of physicians (Moscow, 20 November, 2019). The document is intended primarily to assess adherence to drug therapy, lifestyle modification, and medical support for patients who need long-term or permanent treatment. By the adherence to treatment, the authors of the document consolidated the compliance of the patient's behavior with the recommendations received from the doctor regarding medication, diet and other measures of lifestyle change. Insufficient adherence to treatment is a global problem. Assessing adherence as a basis for making medical decisions is a critical part of improving the quality of the health system. Predictions of treatment outcomes cannot be considered effective if individualized levels of adherence are not used to justify project planning and evaluation. In medical practice, quantitative assessment of adherence is preferred, universal for patients with various diseases and with the possibility of automated data entry and processing. Sections on medical interventions based on assessment of treatment adherence should be reflected in national clinical guidelines. These Joint Recommendations are based on these provisions. Key words: adherence, quantitative assessment, drug therapy, medical support, lifestyle modification, treatment management. For citation: Nikolaev N.A., Martynov A.I., Skirdenko Yu.P. et al. Management of treatment on the basis of adherence. Consensus document - Clinical recommendations. RSMSIM, SSGR, NATH, SEBN, GS RAS, RSH, RSP Consilium Medicum. 2020; 22 (5): 9-18. DOI: 10.26442/20751753.2020.5.200078
Consilium Medicum. 2020;22(5):9-18
9-18
Cardiovascular pathology and COVID-19: briefly on the main
Abstract
In the COVID-19 pandemic situation, patients with cardiovascular disease (CVD), which are prevalent in the population, form a special risk group. The combination of COVID-19 and CVD provides additional challenges for the diagnosis, choosing treatment tactics and routing of patients. The situation is complicated by a lack of information, often conflicting data and the extremely importance of resolving a number of issues for clinical practice. This review focuses on the most important aspects of the combination of CVD and COVID-19. The mechanisms of the pathological effect of COVID-19 on the cardiovascular system, the epidemiological aspects of combining these pathologies in terms of the effect on patient mortality, the effect of comorbid pathology on the prognosis of patients with COVID-19 in comparison with other respiratory viral diseases, the pathomorphological features of tissue changes with COVID 19, as well as side effects that may occur on the part of the cardiovascular system when using drugs to treat patients with COVID-19. In addition, the safety and feasibility of treatment with statins, ACE inhibitors, angiotensin II receptor blockers, or other renin-angiotensin system blockers for outcomes in patients with COVID-19 were discussed. Key words: cardiovascular diseases, COVID-19, respiratory viral infection, inhibitors of the renin-angiotensin-aldosterone system, drugs for the treatment of COVID-19, pathoanatomical study. For citation: Nedogoda S.V. Cardiovascular pathology and COVID-19: briefly on the main. Consilium Medicum. 2020 (22); 5: 19-21. DOI: 10.26442/20751753.2020.5.200157
Consilium Medicum. 2020;22(5):19-21
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Acute respiratory viral infections and heart
Abstract
Acute respiratory viral infections (ARI) is the most widespread group of infections that includes flu, coronavirus, adenovirus, and other infections. There is a direct correlation between increase in ARI incidence and increase of incidence of cardiovascular disorders such as acute myocardial infarction, myocarditis, arrythmia, cardiac insufficiency, pulmonary artery thromboembolia, and disseminated intravascular clotting. Patients with ischemic heart disease, cerebrovascular disease, arterial hypertension, and diabetes mellitus are most vulnerable to ARI negative impact on cardiovascular system. Changes of cardiovascular system caused by ARI are not always clinically evident. Their manifestation (clinical symptoms, cardiac cavity dilatation, hemodynamics disorders) may be postponed, may increase for several weeks or months. Timely diagnosis of cardiac pathology that developed in association with previous ARI depends on general practitioners and family doctors. All cases of development of dyspnoea, cardialgia, or arrythmia are indications for additional examination tests performance (electrocardiography, cardiac injury markers, natriuretic peptides) that will allow to confirm or exclude myocardium involvement and define management strategy. In many cases presence of myocardium pathology and its genesis become evident only in follow-up. Key words: acute respiratory viral infection, cardiovascular disorders, myocarditis. For citation: Kirichenko A.A. Acute respiratory viral infections and heart. Consilium Medicum. 2020; 22 (5): 22-27. DOI: 10.26442/20751753.2020.5.200136
Consilium Medicum. 2020;22(5):22-27
22-27
Sports medicine and sports population under conditions of the coronavirus epidemic
Abstract
In the context of the coronavirus pandemic, there are unclear long-term prospects for returning to full-fledged competitive sports, employment and well-being of athletes, personnel, and the sports industry, causing considerable tension in society. In this regard, an uncontrolled increase in sports and parasports activity can be expected after the removal of epidemiological restrictions. Under these conditions, preparing the medical community for the return of a full-fledged sports movement, developing measures to monitor the health status of athletes, as well as the interaction of athletes, spectators and maintenance personnel, is of great importance. The aim of the work is to evaluate the information on this topic existing in medical journals, online resources and social networks, and confirmed by the positions of leading experts. Key words: SARS-CoV-2, COVID-19, return to sport, cardiovascular system, myocarditis, respiratory system. For citation: Badtieva V.A., Sharykin A.S., Zelenkova I.E. Sports medicine and sports population under conditions of the coronavirus epidemic. Consilium Medicum. 2020; 22 (5): 28-34. DOI: 10.26442/20751753.2020.5.200181
Consilium Medicum. 2020;22(5):28-34
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Cardiology: genetics’ time
Abstract
Hereditary cardiovascular diseases are of great importance in the structure of cardiovascular disease. The article provides a review of materials on genetically mediated heart diseases, which were discussed at the "Genetics and Heart" First International Congress (Moscow). The most relevant current date on hypertrophic and dilated cardiomyopathies as well as hereditary issues of arrhythmogenesis are presented. The main participants of the congress are listed. Key words: hypertrophic cardiomyopathy, dilated cardiomyopathy, channelopathy, arrhythmogenic cardiomyopathy, pulmonary hypertension, myocardium genetic diseases, “Genetics and Heart” Congress. For citation: Sonicheva N.A., Zateyshchikov D.A. Cardiology: genetics’ time (by the materials of the “Genetics and Heart” Congress, January 24-25, 2020, Moscow). Consilium Medicum. 2020 (22); 5: 35-39. DOI: 10.26442/20751753.2020.5.200185
Consilium Medicum. 2020;22(5):35-39
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How to improve anticoagulant therapy in atrial fibrillation?
Abstract
Atrial fibrillation is the most important risk factor for stroke, and as a preventive strategy in these patients anticoagulant therapy are must be prescribed. Currently, pivotal clinical guidelines emphasize the superiority of direct oral anticoagulants (DOACs) over vitamin K antagonists. At the same time, difficult cases in clinical practice are often encountered, patients’ risk of ischemic and bleeding events may significantly change, they also may have a burden of various comorbidities, impaired renal function and/or exposed to surgical intervention. These factors make it difficult to choose the optimal anticoagulant therapy strategy and prescribe optimal DOAC. Also, due to the prevailing adverse epidemiological conditions, it is impossible to ignore the potential effects of the new coronavirus infection on patients with atrial fibrillation. In such complex clinical cases, among the DOACs, the first choice drug is apixaban, due to its extensive body of evidence (both according to randomized clinical trials and real world data), which confirms the optimal efficacy and safety balance in above mentioned patients. Key words: atrial fibrillation, direct oral anticoagulants, apixaban, clinical practice, high risk of stroke/bleeding, coronary artery disease, chronic kidney disease, surgical intervention, COVID-19. For citation: Kochetkov A.I., Ostroumova O.D., Lyakhova N.L., Butorov V.N. How to improve anticoagulant therapy in atrial fibrillation? Consilium Medicum. 2020; 22 (5): 40-48. DOI: 10.26442/20751753.2020.5.200151
Consilium Medicum. 2020;22(5):40-48
40-48
Management of patients with chronic heart failure and diabetes mellitus from the standpoint of modern recommendations and in real clinical practice
Abstract
Aim. Our aim was to assess the accordance of treatment of patients with chronic heart failure and diabetes mellitus (CHF+DM) in real clinical practice with current guidelines and its association with prognosis. Materials and methods. We analyzed 2144 cases of patients admitted to а hospital due to decompensation of CHF in the period from 2014-2018. 207 (9.7%) of these patients had CHF with a left ventricular ejection fraction of <45% and type 2 diabetes [median of age was 69 (interquartile range of 62; 77) years]. The analysis of recommended medications at discharge and survival was performed. Results. Аngiotensin-converting enzyme inhibitors were prescribed to 132 (63.7%) patients: enalapril - 61 (29.4%), perindopril - 42 (20.3%), fosinopril - 29 (14.0%). The angiotensin II receptor antagonist losartan was prescribed to 10 (4.8%) patients. Beta-blockers were prescribed to 188 (90.8%) patients: bisoprolol - 149 (72.0%), metoprolol succinate - 2 (1%), carvedilol - 1 (0.5%). In addition, 36 (17.4%) patients were prescribed metoprolol tartrate not recommended for the treatment of heart failure. Diuretic therapy was prescribed in 200 (96.6%) patients: furosemide - 177 (85.5%), torasemide - 22 (10.6%), indapamide - 1 (0.5%). Mineralocorticoid receptor antagonist spironolactone was recommended 165 (79.7%) patients. Despite the persistence of heart failure III-IV NYHA functional class despite combined medical treatment in 95.1% of patients, the angiotensin receptor and neprilysin inhibitor and/or If-channel blockers and/or cardiac resynchronization therapy weren’t recommended. For glycemic control, metformin was prescribed to 28 (13.5%) patients, gliclazide SR - 53 (25.6%), insulin - 59 (28.5%); combination of metformin and gliclazide SR - 4 (1.9%), metformin and insulins - 5 (2.4%), gliclazide SR and insulins - 5 (2.4%), glimepiride and insulins - 3 (1.5%) patient. During 132 (92; 200) weeks follow up after discharge 107 (67.3%) patients died. The number of deaths was less - 19 (35.2%) in the group of patients whom the therapy in accordance with guidelines was prescribed and who were compliant compared to 88 (83.8%) deaths in others - p (x2)<0.000001. Conclusion. In order to improve the prognosis in patients with heart failure and diabetes mellitus in real clinical practice, it is necessary to carry out treatment strictly in accordance with current guidelines and use the modern achievements in cardiology, including ARNI, If-channel blockers, CPT and etc. Key words: chronic heart failure, diabetes mellitus, guidelines, reduced and middle left ventricular ejection fraction, drug therapy, prognosis, real practice. For citation: Reznik E.V., Lazarev V.A., Kalova M.R., Nikitin I.G. Management of patients with chronic heart failure and diabetes mellitus from the standpoint of modern recommendations and in real clinical practice. Consilium Medicum. 2020; 22 (5): 50-56. DOI: 10.26442/20751753.2020.5.200198
Consilium Medicum. 2020;22(5):50-56
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Meldonium as a supernosological drug
Abstract
A review of the efficacy and safety of meldonium as a drug for “hub” or “supernosological” pharmacotherapy in patients with a wide range of diseases (coronary heart disease and chronic heart failure, rhythm disturbances, intermittent claudication, cerebrovascular disease, diabetes mellitus, asthenia, psycho-vegetative disorders and etc.), as well as the potential mechanisms of action of meldonium, providing its complex effect on a comorbid patient: antihypoxic, antioxidant, cy-toprotective and angioprotective effects, as well as energy protective effect. It has been shown that the spectrum of diseases in which meldonium demonstrates its diverse positive effects suggests that, along with hemodynamic and metabolic effects, it also has a neuroregulatory and neuroadaptogenic effect, which makes it possible to consider it as a “hub” or “supernosological” pharmacotherapy drug. Key words: meldonium, “hub” therapy, supernosological pharmacotherapy, metabolic therapy, comorbidity. For citation: Nedogoda S.V. Meldonium as a supernosological drug. Consilium Medicum. 2020 (22); 5: 57-61. DOI: 10.26442/20751753.2020.5.200208
Consilium Medicum. 2020;22(5):57-61
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Hyperuricemia and chronic heart failure: risk factors and prognostic parallels
Abstract
Background. Hyperuricemia has been considered as the risk factors for cardiovascular diseases in recent years. However, an ambiguous position remains regarding the association of hyperuricemia with a number of cardiometabolic conditions and chronic heart failure (CHF). Aim. To present data on the causes of hyperuricemia, its association with heart failure and the impact on the prognosis of patients with this syndrome. Materials and methods. The search for publications in search systems over the past 15 years was done. The review includes articles from peer-reviewed literature. Results. Many researchers have shown that hyperuricemia is associated with cardiovascular diseases, but studies with Mendelian randomization have not shown conclusive evidence of this association. Changes in the human body from the initiation of risk factors to the clinical symptoms can be both the cause of hyperuricemia and its consequence. Existing data indicate the development of hemodynamic and metabolic changes on the background of activation of neurohumoral systems, which may underlie the close association of hyperuricemia and heart failure, including the worse prognosis. Conclusion. Hyperuricemia is a component of complex pathophysiological, hemodynamic and inflammatory processes, which is why uric acid control in all patients with heart failure is important in order to detect decompensation or disease progression in a timely manner. Key words: risk factor, uric acid, hyperuricemia, heart failure, prognosis. For citation: Larina V.N., Larin V.G. Hyperuricemia and chronic heart failure: risk factors and prognostic parallels. Consilium Medicum. 2020; 22 (5): 62-66. DOI: 10.26442/20751753.2020.5.200158
Consilium Medicum. 2020;22(5):62-66
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Possibilities of modern combined pharmacotherapy using fosinopril in patients with a combined cardiovascular pathology under conditions of ambulatory practice
Abstract
Aim. To conduct a comprehensive comparative assessment of the effectiveness of typical outpatient practice and active combination pharmacotherapy in patients with combined cardiovascular pathology. Materials and methods. Вata obtained from 100 patients aged 45-65 years with concomitant cardiovascular pathology: arterial hypertension of 2-3 grades, stable angina pectoris (I-III functional class), chronic heart failure (I-III functional class). The study was carried out for 32 weeks in 2 stages: at the beginning of the first (observational) stage (1st control point), the patient was initially taken and the initial pharmacotherapy was determined in a typical outpatient practice; 8 weeks after the start of investigation (2nd control point), the efficacy and safety of typical outpatient practice pharmacotherapy were monitored. The intervention was changed using the study scheme (2nd stage, low-interventional). At the end of the 24th week of the intervention, a final evaluation of the results of the study included fosinopril was performed (3rd control point). Results. In the process of implementing typical outpatient practice and active pharmacotherapeutic intervention in patients, a statistically significant improvement in the main studied clinical indicators was revealed, while combined pharmacotherapy was tolerated satisfactorily by all patients. 27% of patients achieved target levels of plod pressure, so their transfer to the strategy of active pharmacotherapeutic intervention was not required. During the second stage of the study, statistically significant positive dynamics rampared to typical outpatient practice were revealed: according to the main indicators of the serum lipoprotein spectrum, daily monitoring of blood pressure and ECG, sonographic parameters of the left ventricle, dynamics of life quality, as well as anxiety and depression scales. Conclusion. The data obtained once again confirm that modern pharmacotherapy containing ACE inhibitors as a blocker of RAAS is a first-line therapy in high-risk patients with cardiovascular pathology and they certainly speak in favor of combined therapy in comorbid patients in combination with hypertension, CHD and CHF. Key words: combined cardiovascular pathology, outpatient practice, fosinopril, pharmacotherapy. For citation: Luneva Ju.V., Povetkin S.V., Kornilov A.A. Possibilities of modern combined pharmacotherapy using fosinopril in patients with a combined cardiovascular pathology under conditions of ambulatory practice. Consilium Medicum. 2020; 22 (5): 67-72. DOI: 10.26442/20751753.2020.5.200209
Consilium Medicum. 2020;22(5):67-72
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Prognostic significance of contrast-induced acute kidney injury in chronic coronary artery disease patients
Abstract
Aim. The aim of our study was to assess the 5-year prognostic significance of contrast-induced acute kidney injury (CI-AKI) in patients with chronic coronary artery disease (CAD). Materials and methods. 561 patients with stable CAD and indications for procedures with intraarterial contrast media administration were included in prospective open cohort study (ClinicalTrials.gov ID NCT04014153). CI-AKI was defined as the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48 hours after administration of contrast media. The primary endpoint was CI-AKI according to KDIGO criteria. The secondary endpoints were total mortality, cardiovascular mortality, myocardial infarction, stroke, gastrointestinal bleeding, acute decompensation of heart failure, coronary artery bypass grafting, repeat percutaneous coronary intervention. Most of the patients, included in the study, were males aged 59.3±11.2 years with arterial hypertension and overweight (BMI 28.8±4.6 kg/m2). Results. CI-AKI was diagnosed in 104 (18.5%) patients. The rate of CI-AKI using the absolute creatinine rise definition was 17 cases (3%). The logistic regression model including age, weight, BMI, female gender, heart failure, proteinuria, arterial hypertension, anemia and baseline serum creatinine, was created. Age, female gender, heart failure, proteinuria and baseline creatinine were statistically significant (p<0.05) risk factors in the model obtained. During 5-year follow-up period CI-AKI seemed to increased the risk of acute decompensation of heart failure and stroke. Conclusion. Elderly female patients suffering from heart failure, proteinuria with higher levels of serum creatinine need more attention and preventive measures before contrast media administration. CI-AKI may indirectly lead to the increased risk of acute decompensation of heart failure and stroke, according to our single-center prospective study. Key words: contrast-induced acute kidney injury, contrast-induced nephropathy, contrast-associated acute kidney injury, coronary artery disease, percutaneous coronary intervention, contrast, prognosis, mortality. For citation: Mironova O.Iu., Fomin V.V. Prognostic significance of contrast-induced acute kidney injury in chronic coronary artery disease patients. Consilium Medicum. 2020; 22 (5): 73-76. DOI: 10.26442/20751753.2020.5.200218
Consilium Medicum. 2020;22(5):73-76
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Choice of treatment policy for patient with coronary heart disease: clinical discussion
Abstract
The most important condition for the dispensary management of patients with chronic coronary heart disease and improve his prediction is achievement target values of three indicators state health according with the Russian clinical recommendations: blood pressure, heart rate and low density lipoprotein. Presented clinical discussion demonstrates opportunities of modern drug therapy to achieve target levels recommended indicators and initiates physicians to strict compliance with clinical recommendations for the dispensary management of patients with chronic coronary heart disease. Key words: coronary heart disease; chronic coronary heart disease; chronic coronary syndrome; stable angina. For citation: Viktorova I.A., Ivanova D.S., Trukhan D.I. et al. Choice of treatment policy for patient with coronary heart disease: clinical discussion. Consilium Medicum. 2020; 22 (5): 77-82. DOI: 10.26442/20751753.2020.5.200146
Consilium Medicum. 2020;22(5):77-82
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Fractalkin and cardiovascular disease
Abstract
Fractalkine (or chemokine CX3CL1) belongs to the chemokine family and is a protein with a molecular weight of 95 kDa, is considered as a marker of endothelial dysfunction. According to the available data of modern studies, fractalkine can be positioned as a marker of the activity of inflammatory processes of different genesis; as an important prognostic indicator in chronic heart failure of both ischemic and non-ischemic etiology and a marker for monitoring the effectiveness of the treatment in this group of patients; as a predictor of adverse outcomes and an indicator of the effectiveness of percutaneous coronary intervention in patients with acute myocardial infarction, a valuable prognostic marker for patients with stable angina (with hemodynamically significant stenosis of the coronary arteries), as well as a predictor of thrombotic and thromboembolic complications in atrial fibrillation. Currently, it is a highly promising to study drug effects on fractalkine (CX3CL1) and its receptor (CX3CR1) for the pathogenetic treatment of cardiovascular diseases. Key words: fractalkine, atherosclerotic cardiovascular diseases, chronic heart failure, acute myocardial infarction, left ventricle. For citation: Alieva A.M., Almazova I.I., Pinchuk T.V. et al. Fractalkin and cardiovascular disease. Consilium Medicum. 2020; 22 (5): 83-86. DOI: 10.26442/20751753.2020.5.200186
Consilium Medicum. 2020;22(5):83-86
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Possibilities of reperfusion therapy for patients with acute myocardial infarction
Abstract
Aim. To study the clinical and laboratory characteristics of patients with acute ST-segment elevation myocardial infarction (STEMI) depending on management tactics. Materials and methods. 133 patients with a diagnosis of STEMI were included. We evaluated the clinical and laboratory characteristics of hospitalization, in the dynamics of inpatient treatment. The prognosis of hospital mortality of patients was calculated on the GRACE scale. All patients with STEMI are divided into groups of drug therapy, percutaneous coronary intervention (PCI), and thrombolytic therapy (TLT). Statistical processing with application programs Statistica 10.0 for Windows. Results. The age of STEMI patients in the PCI group is younger than in patients with drug therapy (p<0.05) and TLT (p<0.05). Patients in the PCI group had the lowest risk of hospital fatality on the GRACE scale. The level of NTproBNP in patients with STEMI remained high during the hospital stage of treatment. The level of ST2 at discharge from the hospital decreased to reference values. More than 90% of patients with STEMI received double disaggregant, anticoagulant therapy, and blockers of the renin-angiotensin-aldosterone system, regardless of management tactics. Conclusion. The management of STEMI reflects the prognosis of patients. The level of NTproBNP and ST2 will increase in the first day of the disease. Performing a PCI reduces ST2 values to normal values, which reflects an improvement in the forecast. Key words: acute myocardial infarction, reperfusion therapy. For citation: Khorolets E.V., Shlyk S.V. Possibilities of reperfusion therapy for patients with acute myocardial infarction. Consilium Medicum. 2020; 22 (5): 87-91. DOI: 10.26442/20751753.2020.5.200182
Consilium Medicum. 2020;22(5):87-91
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P2-ADRENERGIC RECEPTORS GENETIC POLYMORPHISM, CARDIOVASCULAR DISORDERS AND INFLUENCE OF P-BLOCKERS’ EFFECTIVENESS
Abstract
A scientific review of clinical and genetic research data on the role of p2-adrenergic receptor polymorphism in the development and outcomes of cardiovascular diseases is presented. Of the greatest importance in the genetic polymorphism of p2-adrenergic receptors are three loci - Arg16Gly, Gln27Glu and Thr164Ile. Variant alleles Gly16 and Glu27 alter the degree of suppression (down-regulation) of receptor expression against the background of agonist stimulation, which also affects the response of p-blockers. The variant allele Ile164 is extremely rare and leads to a decrease in the functional activity of the receptor. Vascular effects in carriers of the Arg16 and Gln27 alleles are manifested by lower initial blood flow and significantly weakened agonist-stimulated vasodilation compared to carriers of variant alleles Gly16 and Glu27. However, their role in the development of arterial hypertension has not been confirmed. Polymorphism of p2-adre-nergic receptors showed the greatest significance in terms of its effect on cardiac function, the development of adverse outcomes and survival in chronic heart failure, acute coronary syndrome and other cardiovascular diseases. Key words: genetic polymorphism, p2-adrenergic receptors, p-blockers, cardiovascular outcomes, arterial hypertension, heart failure. For citation: Leonova M.V. p2-Adrenergic receptors genetic polymorphism, cardiovascular disorders and influence of p-blockers’ effectiveness. Consilium Medicum. 2020; 22 (5): 92-97. DOI: 10.26442/20751753.2020.5.200107
Consilium Medicum. 2020;22(5):92-97
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Impact of different medication groups on drug-induced seizures risk
Abstract
One of the reasons for the development of epileptic seizures (ES) is the effect of certain drugs. Drug-induced ES and status epilepticus can also develop due to administration or withdrawal of a large number of drugs. The most common drug-induced ES are associated with the use of antidepressants, antiepileptic drugs, antibiotics, antitumor drugs, opioid analgesics, anesthetics, etc. Awareness and adequate assessment of the potential risk of the development of drug-induced ES, monitoring and correction of factors that determine and increase the risk of drug-induced ES, as well as the withdrawal or change of drugs that potentially cause ES, are the most important preventive measures to prevent the development of drug-induced ES and status epilepticus. Key words: epileptic seizures, drug-induced seizures, adverse drug reactions. For citation: Ostroumova Т.М., Akimova E.S., Kochetkov A.I., Ostroumova O.D. Impact of different medication groups on drug-induced seizures risk. Consilium Medicum. 2020; 22 (5): 98-105. DOI: 10.26442/20751753.2020.5.200001
Consilium Medicum. 2020;22(5):98-105
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