Vol 8, No 3 (2017)

Relevance. Data from epidemiological studies indicate an increase in the number of patients with chronic heart failure (CHF) in the Russian Federation over the past 18 years. The worsening of the prognosis in patients with CHF after the episode of acute heart failure decompensation (AHFD) requires changes in the tactics of treatment and rehabilitation of patients on an outpatient basis. The goal is to identify the differences in the two strategies for monitoring patients with CHF after AHFD and determine the effectiveness of treatment, rehabilitation and life expectancy, depending on the observation of a specialized urban center for the treatment of CHF (CCHF) and real outpatient practice in the system. Materials and methods. The study included 648 patients with CHF of any etiology older than 18 years. The first group consisted of 412 patients with CHF who were observed for AHFD in the stationary department of the CCHF and, after discharge, continued rehabilitation in the outpatient department of the CCHF; the 2 nd - 236 patients with CHF who, after discharge for AHFD from the department of the CCHF, preferred observation in outpatient clinics in Nizhny Novgorod. Results. After one year of follow-up, the overall mortality rate in the 1st group was 4.13%, and in the second group it was 14.83% (odds ratio 4.0, 95% confidence interval 2.2-7.4, p<0.001 ). Physical activity and rehabilitation potential among patients who were observed in the department of urban CCHD was significantly higher than among patients who were treated in outpatient clinics. The conclusion. Changing the organization of medical care for patients with CHF, especially high grades after AHFD, not only leads to an improvement in the life expectancy and significantly increases the rehabilitation potential during the year of observation in the city's CCHF, which is economically advantageous due to a reduction in the number of hospitalizations for repeated CHF decompensations.

Aim - to evaluate quality of life (QOL) of patients with atrial fibrillation (AF) after surgical treatment of arrhythmia during open heart surgery. Materials and methods. The retrospective single-center randomized study involved 71 patients whose QOL was analyzed after the Cox-Maze IV surgery and mitral valve correction. The follow-up period was from 6 months to 6 years. The study included 35 (49%) women and 36 (51%) men, whose average age was 61±12.3 at the time of surgical treatment. AF duration was 47.6±22.3 months. The left atrium was dilated to 60.9±10.5 mm. Functional class II of heart failure (NYHA) included 25 patients (35%), functional class III - 46 patients (65%). The control group included 48 patients with AF who had not got the ‘labyrinth’ procedure performed during the surgical treatment. There were no statistically significant differences between the main clinical and demographic characteristics in reference to the groups. All patients had a long-term persistent AF. The SF-36 questionnaire was used for studying QOL. Results. 47 (66%) patients in the experimental group kept a sinus rhythm within 6 years. The patients of the RFA-group had a higher rate of vitality (NBS VT 54.5±8.2, p=0.03, SBS VT 54.1±8.5, p=0.001) and social functioning (SBS SF 45.0±10.2, p=0.001), with regard to other scales there were no statistically significant differences. The presence of AF after surgical treatment increased the probability of a low QOL in the long term. Conclusions. QOL after surgical treatment of mitral valve disease and AF is significantly higher with regard to vitality and social functioning. The physical component of health is significantly reduced as compared with that in the general population, but the characteristics of QOL in accordance with other scales approach the general indices. The presence of AF after surgical treatment increases the probability of a lower QOL in the long term.

The presented review concerns the problem of lifestyle changes in primary and secondary prevention of cardiovascular diseases. The results of studies highlighting the positive effects of quitting smoking, controlling blood pressure, body weight and cholesterol on the risks of developing cardiovascular diseases and their complications are highlighted. Attention is paid to the principles of the formation of a healthy diet and increased physical activity. The principles of prescribing statins with different categories of cardiovascular risk of the patient with emphasis on the new statin - pitavastatin are indicated.