Vol 7, No 3-4 (2016)

Goal. The pilot project to organize or conduct performance improvement of existing structural units in specific hospitals (LU) Russia to provide rehabilitative care for patients with cardiovascular diseases in three stages under the current "Procedure for the provision of medical care for patients in medical rehabilitation", to introduce in practice these units tested scientifically sound approaches, forms and methods of cardio-rehabilitation, and try to create some patients routing algorithm. Material and methods. The pilot project includes 17 of the medical institutions of 13 regions of Russian Federation. Single special cards that allow to evaluate the appropriate order on the medical rehabilitation provided rehabilitation assistance to cardiac patients, a multidisciplinary team involved in the provision of rehabilitation assistance, staffing and equipping MI To analyze the effectiveness of organizational models in cardiorehabilitation MI have been developed. Special cards consisted of three sections, each of which allows you to evaluate the effectiveness of each of the three stages cardiorehabilitation: Stage I - unit intensive care unit (BRIT), and a specialized cardiology department; Stage II - stationary cardiorehabilitation department; Stage III - patient department cardiorehabilitation. The article presents the results of a three-year analysis from January 2013 to December 2015. Results. The pilot project was organized with the cardiorehabilitational help stage I in 10 DR, II stage - a 10-LU and Phase III - 7 DR. By 2015, almost all of Latvia to provide assistance in cardiorehabilitational area, multidisciplinary teams consisting of a cardiologist, cardiologist, rehabilitator, medical physical culture (physical therapy) specialist, physical therapy instructor-methodologist, psychotherapist, clinical psychologist, physiotherapist were formed. They were provided and equipped with facilities to practice physical therapy, room for educational schools. Home rehabilitation process BRIT has reduced the patient's stay in the bed of 0.7 days (2013 to 2015) and for 1 day in the cardiology department. On average, 67% of patients with acute myocardial infarction (AMI) were translated into Phase II cardiorehabilitaяtion in which they have become actively involved in the physical rehabilitation program, which is based on a classic exercise therapy, dosage walking in the room, physical training on simulators. Each MI educational schools were organized for patients actively pursued discussions with the relatives. Special complexity of the project has caused the organization phase III cardiorehabilitation. The project is currently ongoing. Conclusion. The analysis of the organization of a three-stage kardioreabilitatsionnoy care system with AMI patients considering the use of staffing, equipment and methodology, according to the current normative law, showed a significant increase in recreational activities created by multidisciplinary teams in all three stages of cardio-rehabilitation, increasing the number of used rehabilitation methods and improve the quality of their performance, as well as demonstrated safety of the proposed principles of physical rehabilitation, according to Russian clinical guidelines "Acute myocardial infarction with ST-segment elevation ECG: rehabilitation and secondary prevention", in the framework of the proposed organizational models cardiorehabilitation.

The problem of prevention of chronic non-communicable diseases continues to be relevant. It is a promising non-invasive integration of new screening methods to assess the patient's health system. The goal was to establish the relationship of vascular endothelial function parameters with indicators of suboptimal health status and the factors of cardiovascular risk. Materials and methods. A total of 327 residents of Samara, who had no history of disease and did not receive treatment in the last 3 months. We used a questionnaire diagnostic screening suboptimal health status SHSQ-25, the risk factors of cardiovascular diseases, endothelin-1, human blood index of endothelial function was determined by computer photopletismography. Results and discussion. Suboptimal health status is associated with the prevalence and severity of cardiovascular risk factors, smoking, overweight, total cholesterol, glucose, blood endothelin, vascular endothelium reactivity, indicating that their dominant influence on the quality of life in a population of healthy individuals. Vascular reactivity non-invasively evaluated in terms of endothelial function in the sample with ischaemia of the upper limb by computer photopletismography reflects systemic vascular endothelial function as a negative associated with endothelin blood and the main factors of cardiovascular risk: age, male gender, body mass index, the nature of work activity, blood pressure value.

In a prospective observational non-interventional study included 148 patients with ischemic stroke at the age of 60 (52; 68) years, with sinus rhythm. At the end of the acute stroke period (21-22 days) was performed Holter monitoring with the assessment of arrhythmias and heart rate variability (HRV). Duration of prospective follow-up was 35 (28; 40) months. We register all cases of cardiovascular death (CD), including death due to recurrent stroke, myocardial infarction (MI), sudden CD (SCD), acute heart failure (AHF), pulmonary embolism. During follow up CD was registered in 15 (10%) patients: in 7 patients - due to recurrent stroke, 2 patients - due to acute MI, in 3 - due to AHF, 3 patients - due to SCD. On multivariate regression analysis in sinus rhythm revealed significant association with the development of CD following factors: age over 67 years, male gender, involvement insula in the area of ischemic damage, supraventricular extrasystoles (more than 54 extrasystoles per day), ventricular arrhythmias, bradyarrhythmias, reduced power range of high-frequency (HF) less than 39 ms2 and low frequency less than 180 ms2 HRV. Separately from the number of these factors with increased risk of fatal complications was significantly associated only two parameters: the involvement insula in the cerebral infarct area (p<0.02) and the power spectrum of the HF<39 ms2 (p<0.04).

The lecture discusses methods of ensuring hemodynamic and neurohormonal unloading of the heart, current recommendations for the prevention of exacerbations of coronary heart disease in patients with myocardial infarction or unstable angina episode. Narrow organizational, diagnostic and therapeutic tasks that need to be addressed at the stage of hospital treatment of patients with acute coronary syndrome. Substantiates the principle of modular construction of individual rehabilitation programs, discussed methodological procedures of obtaining and analyzing the information necessary for the individualization of rehabilitation programs, as well as methods of physical, mental rehabilitation and disability assessment of patients after myocardial infarction.