Репозиторий Университета

© 2017 Elsevier B.V. Background: Hospitalization is an opportunity to optimize heart failure (HF) therapy. As optimal treatment for hospitalized HF patients in sinus rhythm with heart rate ≥ 70 bpm is unclear, we investigated the impact of combined beta-blocker (BB) and ivabradine versus BBs alone on short and longer term mortality and rehospitalization. Methods and results: A retrospective analysis was performed on 370 hospitalized HF patients with heart rate ≥ 70 bpm (150 BB + ivabradine, 220 BB alone) in the Optimize Heart Failure Care Program in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Russia, Ukraine, and Uzbekistan, from October 2015 to April 2016. Results: At 1 month, 3 months, 6 months and 12 months, there were fewer deaths, HF hospitalizations and overall hospitalizations in patients on BB + ivabradine vs BBs alone. At 12 months, all-cause mortality or HF hospitalization was significantly lower with BB + ivabradine than BBs (adjusted hazard ratio [HR] 0.45 (95% confidence interval [CI] 0.32–0.64, P < 0.0001). Significantly greater improvement was seen in quality of life (QOL) from admission to 12 months with BB + ivabradine vs BBs alone (P = 0.0001). With BB + ivabradine, significantly more patients achieved ≥ 50% target doses of BBs at 12 months than on admission (82.0% vs 66.6%, P = 0.0001), but the effect was non-significant with BBs alone. Conclusions: Heart rate lowering therapy with BB + ivabradine started in hospitalized HF patients (heart rate ≥ 70 bpm) is associated with reduced overall mortality and re-hospitalization over the subsequent 12 months. A prospective randomized trial is needed to confirm the advantages of this strategy.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Aim. To evaluate cost effectiveness of coronary endovascular treatment in patients with stable IHD during “one-night” hospitalization. Materials and methods. Using the cost-minimization analysis direct medical cost of coronary endovascular treatment in patients with stable IHD during the “one-night” hospitalization was compared with the “classic” hospitalization. Results. The most cost-effective strategy for hospitalization of patients for transcutaneous coronary intervention (TCI) with stenting was the “one-night” hospitalization. Differences in direct medical costs (DMC) were statistically significant (p=0.01) in favor of the patient group hospitalized for one night. Conclusion. The “one-night” hospitalization plan for patients with stable IHD to undergo TCI with stenting increases the cost-effectiveness due to the decreased number of days of stay in the hospital and the associated decrease in cost of in-patient maintenance, which resultes in considerable financial savings (∆ between the hospitalization plans was 21.2% in favor of the “one-might” hospitalization). This ∆ indicates high cost effectiveness of the selected approach.

© Russian Journal of Cardiology.  Aim. Evaluation of clinical specifics, predictors of repeat hospitalizations and mortality in chronic obstructive pulmonary disease (COPD) patients according to pulmonary hypertension (PH) severity grade. Material and methods. To the study, 288 COPD patients included (II-IV severity grade, GOLD 2016; males 276, females 12; mean age 59,5±9,27 y. o., smoking 23,1±11,42 pack/years; 2,4±0,89 exacerbations annually, body mass index (BMI) 27,2±12,06 kg/m 2 ). According to the presence and grade of systolic pressure increase in pulmonary artery (SPPA) the patients were selected to three groups: 1st — with no PH (SPPA <40 mmHg, n=168), 2nd — with moderate PH (SPPA 40-55 mmHg, n=101), 3rd — with severe PH (SPPA >55 mmHg, n=19). Results. Increase of SPPA was found in 120 (41,7%) patients: moderate PA — in 101 (35,1%), severe PH — 19 (6,6%). It was shown that the presence and severity of PH do increase the severity of clinical signs of COPD, hemodynamic disorders, increase the rate of repeat hospitalizations and mortality rate. The predictors of repeat hospitalizations in COPD patients are increased SPPA and C-reactive protein concentration (CRP); mortality predictors are severity of symptoms by CAT, Borg dyspnea, number of exacerbations during one year, size of the right atrium, grade of SPPA increase, CRP concentration, fibrinogen, N-terminal precursors of C-natriuretic peptide (NT-proCNP) and brain peptide (NT-proBNP) in the blood. Conclusion. PH in COPD patients in most cases is moderate, and it worsens the clinical picture, hemodynamic disorders, shows only moderate correlation with breathing disorders, increases the rate of rehospitalizations and mortality risk. The survival rate of COPD and PH patients depends on the severity.