Helps reduce mortality from cardiovascular diseases. Mortality from cardiovascular diseases. Consequences of the Program implementation and risk assessment of its implementation

Among premature deaths in our country, cardiovascular diseases have long and firmly held first place. And in terms of mortality from acute heart attack myocardium Russia occupies one of the leading places in the world. Why?

We turned to leading cardiologists for an answer.

Bitter realities

Until the thunder strikes, the man will not cross himself - the overwhelming majority of our fellow citizens profess such an attitude towards their own health. Experts have been sounding the alarm for a long time: despite the efforts being made in our country to prevent and treat heart disease, vascular diseases, no significant reduction is observed. According to data presented by the Russian Society of Cardiology and the Arterial Hypertension Society, 40-42% of the adult population has high blood pressure.

The situation is no better with the control of other risk factors that lead to coronary heart disease, and ultimately to acute myocardial infarction. We are talking about disorders of lipid and carbohydrate metabolism. The recent NATION All-Russian epidemiological study to assess the prevalence of type 2 diabetes mellitus, which involved more than 26 thousand people aged 20 to 79 years from 63 regions of Russia, leads to sad thoughts: 54% of people with diabetes identified during the study do not knew about their illness.

For doctors, this state of affairs causes nothing but grief.

Maria Glezer, chief freelance cardiologist of the Ministry of Health of the Moscow Region, professor of the Department of Preventive and Emergency Cardiology of the First Moscow State Medical University named after I.M. Sechenov, Doctor of Medical Sciences:

Today in the Moscow region there are 26 health centers for adults and 8 for children, 8 prevention centers (including at the regional level). There are prevention rooms in every clinic.

Specially trained doctors work there, and if desired, every resident of the Moscow region who has compulsory medical insurance policy, it is possible to quickly, within one day, undergo basic screening examinations, and if necessary, receive a referral for a more in-depth examination and consultation with medical specialists. But, unfortunately, not everyone takes advantage of this opportunity.

Dangerous scenario

Our fellow citizens also underestimate the risk that arises as a result of acute coronary circulatory disorders. Having analyzed the data on how much time passes from the onset of an attack to contacting the “ ambulance“Regarding the squeezing, pressing or burning pain behind the sternum, which is not relieved by taking nitroglycerin, experts were puzzled: this period sometimes reaches... 5-6 hours, or even 2-3 days! And this despite the fact that recently in our country there has been a situation with the provision of emergency medical care patients with myocardial infarction improved.

Dmitry Napalkov, Professor of the Department of Faculty Therapy No. 1 of the First Moscow State Medical University named after I. M. Sechenov, Doctor of Medical Sciences:

The introduction of an algorithm for helping patients with acute myocardial infarction and coronary syndrome, the re-equipment of vascular departments of hospitals and the emergence of new vascular centers have led to the fact that mortality from heart attack in our country has decreased significantly.

It could have decreased even more if not for the arrogance of our citizens. People often endure until the last minute, not suspecting that from the moment heart pain occurs, only 90 minutes are allotted to save heart cells, and sometimes their lives. These are the canons of emergency medical care for myocardial infarction, one of the cornerstone principles of which is the maximum possible reduction in the time of delivery of the patient to the hospital. This period is called the “therapeutic window,” during which it is necessary to restore the patency of the vessels supplying the heart: either by introducing special drugs, or by using stenting, in which a thin metal spacer is inserted into the damaged vessel under the control of special equipment.

Area of ​​responsibility

Doctors also have many questions about how patients, even those who have already suffered a heart attack, follow medical recommendations.

Maria Glezer:

Today in our country we use absolutely the entire arsenal of medicines that are available in the world for the treatment and prevention of cardiovascular diseases. The problem is that people do not always use even well-chosen medications correctly: they skip doses, change doses themselves, do not take some of the prescribed medications, which leads to a decrease in the effectiveness of treatment.

However, there is another problem that doctors talk about with alarm and pain: interruptions in procurement auctions discounted medications, the list of which, according to experts, contains a lot of unnecessary things, and of those that exist, not all of them are the most effective. But a way out of this situation could also be found.

Dmitry Napalkov:

I have long been talking about the need to monetize benefits, providing some kind of social and financial support to our citizens, who, having paid a little extra, could go to the pharmacy for more expensive, but, most importantly, better quality drugs. Taking into account the crisis situation, not a single state, even the most advanced one, can afford to provide them to everyone in full. But are our citizens, many of whom are accustomed to receiving treatment for free, ready for such a step?

Experts agree on the following conclusions: in order to reverse the situation, the efforts of the medical community alone are not enough. It is necessary to change the attitude of citizens themselves towards their own health, for whom it is time to understand: first of all, this is an area of ​​our personal responsibility. And already in the second - a doctor.

How to recognize a heart attack:

You urgently need to dial “103” if there is pain in the heart area:

• is not similar to the previous ones and is not controlled by a standard dose of nitro drugs;
• lasts more than 15 minutes;
• radiates to the shoulder, epigastric region, jaw, neck;
• first occurred in a man over 30-35 years of age or in a woman over 40-45 years of age;
• accompanied by cold sweat, shortness of breath, general weakness, rising blood pressure.

Before the ambulance arrives, it is not prohibited to take nitrospray once or twice (preferably in a sitting or lying position, this prevents a sharp decrease in blood pressure and the appearance of fainting).

What leads to disaster:

High blood pressure

The risk of dying from a heart attack is much higher if high blood pressure is added to the increase in cholesterol levels.

What to strive for: Normally, blood pressure should not be higher than 140/90 mm Hg.

Lipid metabolism disorder

An increase in blood cholesterol levels of just 10% increases the death rate from heart attack by 15%.

What to strive for: Optimally, the level of low-density lipoprotein (LDL) “bad” cholesterol is less than 3.0 mmol/L, and total cholesterol is less than 5.0 mmol/L.

Smoking

People who smoke have an 8-10 times higher risk of developing cardiovascular diseases. Smoking is especially dangerous for women. For them, even one cigarette a day becomes a risk factor for the heart.

What to strive for: to a gradual reduction in the number of cigarettes smoked and to a complete cessation of tobacco.

Obesity

In people with excess body weight, the risk of developing a heart attack is 3-4 times higher (especially if obesity is combined with high blood pressure, high cholesterol and blood glucose levels).

What to strive for: to the normal waist size, which for women should be less than 80 cm, for men - less than 94 cm.

High blood glucose levels

A round of elevated blood glucose leads to a whole trail of hormonal and metabolic disorders, which primarily lead to damage of cardio-vascular system. In 80% of cases, patients with diabetes die from heart attacks and strokes.

What to strive for: According to the recommendations of the World Health Organization, the normal level of plasma glucose (blood from a vein) on an empty stomach is less than 6.1 mmol/l, and 2 hours after the stress test - less than 7.8 mmol/l.

When to get examined

Starting from 40 years of age (for men) and 45 years of age (for women), it is necessary to undergo an annual cardiac examination, which includes:

• blood test for cholesterol levels and various
• its fractions (lipid profile)
• blood test for blood glucose levels
• level analysis uric acid
• ECG, echocardiogram (if indicated)
• Ultrasound carotid arteries(if there are risk factors)

Memo for patients after a heart attack

Is it possible to live after a heart attack? full life and avoid its recurrence?

Doctors say: it’s possible. The main thing is to follow a number of important rules.

Take necessary medications.

Namely: ACE inhibitors, beta blockers, antiplatelet agents and statins. Patients who have had a heart attack must take these medications for the rest of their lives.

Visit a cardiologist regularly.

Preferably the same person who knows your medical history well and can adjust the dose of medications.

Maintain optimal levels of blood pressure and pulse.

In a person who has had a heart attack, target blood pressure values ​​should be higher than is customary for hypertension: systolic (upper) - no lower than 120 and no higher than 150, and diastolic (lower) - no higher than 90. In this case, the recommended pulse rate should be 56-60 beats per minute.

Don't lie down!

The sooner a patient begins physical rehabilitation after an uncomplicated heart attack, the better. First, with the help of massage, walking on a cardio machine. The part of the heart muscle that remains healthy after a heart attack needs training.

Five steps to a healthy heart

Monitor blood pressure levels

World experience of recent decades shows that thanks to control of blood pressure, which must be measured regularly starting from the age of 40, it was possible to reduce the incidence of myocardial infarction by 30%, and stroke by 50%.

Quit smoking and do not abuse alcohol

According to the Ministry of Health of the Russian Federation, in just the first year from the start of the anti-tobacco campaign in our country, as a result of quitting smoking, mortality from cardiovascular diseases decreased by 15.7%.

Establish nutrition

Reduce salt intake to 5 g per day.

Limit your consumption of sweets (sugar, honey, baked goods).

Limit consumption of animal products rich in cholesterol (fatty meat, sausages, fatty cheeses and dairy products, canned food).

There are more products plant origin(raw vegetables and fruits). The average norm is 600 g per day.

Move more

The best option is walking at a brisk pace (preferably in the fresh air), the average norm is 10 thousand steps per day (3-5 km). Swimming and cycling are also beneficial for vascular health.

Develop resistance to stress

First, improve your sleep, which should average at least 8 hours a day. Maintain alternating work and rest schedules.

In 2017, cardiovascular diseases claimed the lives of 858 thousand people, which is 5% less than the year before. The death rate has reached its lowest level since the beginning of the decade. The Ministry of Health believes that mass clinical examination and the creation of vascular centers throughout the country played a role in this. According to experts, the focus is now on reducing mortality from circulatory disorders increased attention, as it leads to an increase in life expectancy and a strengthening of the economy.

In 2017, the mortality rate from cardiovascular diseases fell below 600 per 100 thousand population for the first time since the beginning of the decade. This is evidenced by Rosstat data, which Izvestia reviewed. Last year, 858 thousand people died from diseases of the circulatory system - 5% less than in 2016. This is 584.7 cases per 100 thousand population.

A systematic decline has been observed since 2010. But cardiovascular diseases still remain the main cause of death for Russians - almost half (47%) of deaths.

MORE ON THE TOPIC

The main weapon in the fight against circulatory disorders is prevention, the Ministry of Health notes. Mortality continues to decline thanks to mass medical examinations, which have been carried out in the country since 2013. This made it possible to increase surveillance coverage of the population by 18% - to almost 59 million people, which makes it possible to more often detect diseases in early stages.

In addition, there are more than 593 vascular centers in the country, where they have implemented modern technologies management of patients with complex conditions.

As a result, mortality from strokes decreased by 25%, from myocardial infarction - by 14%, the Ministry of Health said.

Cardiovascular diseases are in first place in the overall mortality statistics in many countries of the world, noted the deputy director of the Institute of Cardiac Surgery. IN AND. Burakovsky Yuri Buziashvili. According to him, in last years doctors began to actively use invasive examination methods (with penetration into the organ itself, for example, cardiac probing or vascular catheterization).

A decrease in mortality from cardiovascular diseases leads to an increase in the average life expectancy of Russians. This is a direct contribution to the Russian economy, which is why increased attention is paid to diseases of the cardiovascular system, explained Yuri Krestinsky, director of the Institute for the Development of Public Health.

In recent years, many clinics with high-tech equipment have indeed been opened and a network of vascular centers has been developed. These measures help to respond quickly and save patients, he explained.

Earlier, Izvestia reported that it is planned to allow the use of defibrillators for first aid. For now this is prohibited, because this method cardiopulmonary resuscitation not on the list approved by order of the Ministry of Health. The department plans to correct this situation. After this, defibrillators may appear in crowded places - at train stations, airports, subways, stadiums.

RUSSIAN FEDERATION
CITY DUMA
CITY DISTRICT "CITY OF KALUGA"

RESOLUTION

On approval of the city target Program "Reducing mortality from cardiovascular diseases for 2008-2010."

In order to implement measures aimed at improving demographic indicators in the municipal formation "City of Kaluga", reducing mortality from controllable causes and developing preventive areas in municipal health care institutions, in accordance with Art. 26 of the Charter of the municipal formation "City of Kaluga" City Duma of the urban district "City of Kaluga"

Resolved:

1. Approve the city target Program "Reducing mortality from cardiovascular diseases for 2008-2010." (application).

2. This Resolution comes into force after its official publication.

3. Control over the implementation of this Resolution is entrusted to the Committee of the City Duma of the urban district "City of Kaluga" on issues social development(Staviskaya M.V.).

Deputy City Mayor
Yu.N.Logvinov

Application. PROGRAM "REDUCING MORTALITY FROM CARDIOVASCULAR DISEASES FOR 2008-2010"

Application
to the Resolution of the City Duma
urban district "City of Kaluga"
dated December 14, 2007 N 179

Passport of the city target Program "Reducing mortality from cardiovascular diseases for 2008-2010"

1. Characteristics of the problem (task), the solution of which is carried out through the implementation of the Program

Over the past decades, there has been a decline in the level of population health to critical levels. low indicators. This is manifested primarily in high rates of morbidity and mortality, as well as excess mortality in men of working age. Currently in Russian Federation There is a tense epidemiological situation associated with a sharp increase in the incidence of arterial hypertension, which is not only one of the main risk factors for the development of diseases of the circulatory system and mortality from them, but also the most common disease.

In the structure of causes of overall mortality in Russia, mortality from diseases of the circulatory system is 56 percent.

Of the deaths from cardiovascular diseases, 48% are coronary heart disease, which is closely related to hypertension. Mortality from cerebrovascular stroke, which most often occurs against the background of hypertension, is 35.2% of the total. Mortality from hypertension was noted in 6% of total cardiovascular mortality. All this means that more than 75% of deaths are closely related to arterial hypertension.

In the Russian Federation, the number of patients with arterial hypertension reaches many millions (according to sample studies, 25-30% of the adult population suffers from arterial hypertension). In the working age population, vascular diseases are detected in 20% of individuals, of which 65% have arterial hypertension. Brain strokes in Russia are 4 times more common than in the USA and a number of Western European countries.

Coronary heart disease and acute myocardial infarction are one of the leading causes of hospitalization and the leading cause of death in developed countries. In the United States, coronary heart disease is the cause of death for approximately 500 thousand people annually, and acute myocardial infarction develops in 1.5 million people annually. The cause of myocardial infarction in 95% of cases is occlusion or stenosis coronary arteries.

According to the European Society of Cardiology, acute myocardial infarction ranks first in terms of incidence per capita with a tendency to increase every year. About 650 thousand Europeans die annually from coronary heart disease, and acute myocardial infarction annually causes death in about 420 thousand people.

In the Russian Federation in 2006, the incidence of coronary heart disease (per 100 thousand adult population) was 483, an increase of 3.2% compared to the previous year. The incidence of acute myocardial infarction was 147 (per 100 thousand adult population) with an increase of 2.6% compared to the previous year.

The same trend is observed in Kaluga and the Kaluga region. In the structure of mortality of the region's population, the first place is occupied by diseases of the circulatory system - 59.7%. The incidence of circulatory system diseases is 32.0 per 1000 population of the Kaluga region. At the end of 2006, 27,729 people were registered at the dispensary for arterial hypertension, and 6,877 cases of temporary disability due to arterial hypertension were registered. Over the course of a year, 3,500 people are again identified as suffering from stage II hypertension.

Scientifically based data show that as a result of timely and correct treatment of arterial hypertension, a decrease in cardiovascular morbidity and mortality should be expected.

In European countries, systematic antihypertensive therapy is carried out in 50-60% of patients with arterial hypertension. Treatment of a wide range of such patients has led to a significant reduction in the number of cerebral strokes. This dependence so pronounced that the quality of treatment of arterial hypertension in some countries began to be assessed by the dynamics of cerebral stroke indicators. No matter how offensive it may be, according to these indicators Russia ranks one of the last places in Europe. Unfortunately, in Russia only 57-60% of patients are informed about the presence of arterial hypertension, of which 17-20% of patients receive antihypertensive therapy, and it is effective this treatment occurs in only 6-8% of the total number of people with this pathology. The issue of timely diagnosis and effective treatment arterial hypertension is extremely relevant. Thus, according to a number of studies, with a 10-year history of hypertension, the risk of developing a cerebral stroke increases by 3.5-4.0 times, and the risk of developing myocardial infarction by 2.5-3.0 times.

The epidemiological situation that has developed in recent years in the Russian Federation, associated with the increase in cardiovascular diseases, poses a direct threat to the health of the population, and the losses it causes lead to significant economic damage.

World experience shows that the problem of human and material losses is solvable and preventive activities play a major role in this. The decrease in mortality from cardiovascular diseases in countries such as the USA, Canada, and Finland did not occur as a result of an improvement in the quality of treatment of patients, but mainly as a result of increased efforts to prevent the occurrence of new cases of the disease. In the 1960-1970s, these countries began to carry out preventive measures at the national level aimed at reducing the risk of arterial hypertension caused by a diet with excess amounts of saturated fat and table salt, smoking, alcohol abuse, sedentary lifestyle, increased blood cholesterol, diabetes, etc.

Among the population of the Russian Federation, such risk factors are very widespread, and appropriate preventive work can significantly reduce the incidence, disability and mortality of the population from cardiovascular diseases.

To achieve effective results, it is necessary, first of all, to formulate in people a priority attitude towards the problem of their health. An important role in this is played by informing the population about the dangers of arterial hypertension and its consequences, promoting medical and hygienic knowledge about a healthy lifestyle and recommendations for eradicating bad habits.

Unfortunately, not available in Russia systems approach in organizing and conducting preventive measures acceptance, the procedure for interaction between healthcare and physical education and sports institutions has not been determined, and criteria for assessing the effectiveness of the activities they carry out have not been developed.

Reduction in the volume of preventive work in outpatient clinics, lack of a permanent information and propaganda system, the purpose of which would be to create a desire among the population for healthy image life and disease prevention, lead to the fact that more than 80 percent of patients with arterial hypertension are not detected.

Qualification of local general practitioners, doctors general practice, pediatricians, neurologists and cardiologists do not always correspond to the modern level of medical care provided to cardiac patients, primarily to patients with arterial hypertension. Also, effective programs for the prevention of cardiovascular diseases among adults, children and adolescents for medical workers and school teachers have not been developed.

The equipment of medical institutions providing medical care to patients with diseases of the cardiovascular system also lags behind the needs. There is a lack of equipment for daily monitoring of blood pressure, express analyzers for determining cholesterol levels, and conducting specific tests for the early detection of acute myocardial infarction.

The disadvantage of the widespread implementation of the rules of continuous drug therapy in the treatment of hypertension is the high prices for medications. The patient refuses treatment due to lack of funds to purchase medications.

Global practice has shown that only medicinal methods treatments cannot significantly reduce these rates. That is why the number of surgical methods for treating these diseases, especially minimally invasive, gentle treatment methods, is growing all over the world.

Such methods include balloon angioplasty, stenting of coronary arteries, including acute period: stenting of the infarct-related artery. Timely stenting in acute myocardial infarction (the first 6 hours from the onset) can reduce mortality or disability in the future by 30%.

Planned stenting of the coronary arteries allows patients of working age to be restored to work and the lives of elderly patients to be prolonged with an improvement in the “quality of life.” European indicator of the need for revascularization operations (coronary artery stenting): 1000 operations per 1 million population. In Russia, surgical care for those in need does not exceed 20%.

In the emergency hospital in Kaluga there is a department of cardiac surgery and invasive cardiology, on the basis of which highly qualified, high-tech care is provided to patients with coronary heart disease - revascularization operations (stenting of the coronary arteries). This department has the necessary equipment, 25 beds, and trained medical personnel with experience in providing this medical care. Currently, the waiting list for examination of the coronary arteries (coronary angiography) is 2.5 months, which is unacceptable for patients with severe heart pathology.

The length of the queue is due to insufficient funding for consumables, a lack of paramedical personnel and doctors, which is associated with low wages for workers.

The adoption of the Program will contribute to the implementation of state policy in the field of combating arterial hypertension and its complications, and will allow it to be put into practice effective methods prevention, early diagnosis, treatment and rehabilitation of patients, reduce the number of complications and adverse outcomes caused by diseases of the cardiovascular system. With a complete reduction in circulatory diseases, life expectancy can increase by 9-10 years and reach 68 years for men and 82.8 for women.

2. Main goals and objectives of the Program

The main goal in the implementation of the city target Program is to reduce the mortality rate of the population from diseases of the cardiovascular system.

Achieving this goal is possible by solving the following tasks:

1. Formation of an attitude towards a healthy lifestyle of the population (budget service - organization of primary health care in outpatient clinics);

2. Early detection of cardiovascular diseases, timely treatment and prevention of the development of complications of arterial hypertension (budget service - organization of primary health care in outpatient clinics);

3. Improving the quality of medical care for patients with arterial hypertension, increasing the availability of modern medicines (budgetary service - organizing the provision of primary health care in outpatient clinics);

4. Changes in the procedure for providing emergency medical care to patients with acute myocardial infarction (budgetary service - organization of emergency medical care, provision of primary health care in 24-hour hospitals);

5. Development and increase in availability of cardiac surgical medical care for coronary heart disease, myocardial infarction, rhythm disturbances (budgetary service - organization of primary health care in 24-hour hospitals).

3. Timing and stages of the Program implementation

The implementation of the city's target program "Reducing mortality from cardiovascular diseases" is planned for 2008-2010.

At the first stage (2008), it is planned to carry out activities related to personnel training, strengthening the material and technical base of medical institutions, massive health education of the population and the formation of an attitude towards a healthy lifestyle.

At the second stage (2009-2010), the work begun in 2008 on health education of the population will be continued. Patients of working age with arterial hypertension identified at the first stage will be treated with modern medicines at a discount from their cost. This will create additional motivation for checking blood pressure levels, early detection of hypertension and timely initiation of the treatment process with modern medicines. The number of people under dispensary observation will increase, which will reduce the risk of developing severe complications.

In addition, it is planned to change the system of providing medical care to emergency cardiac patients with an emphasis on cardiac surgical treatment for people of working age. Availability of minimally invasive treatments will increase surgical methods treatment and examination of patients, rehabilitation departments will open on the basis of the Kaluzhskaya city ​​Hospital N 4" and the Kaluga City Hospital N 5 for persons who have suffered a stroke due to hypertension and myocardial infarction.

4. Main activities of the Program

In order to promote a healthy lifestyle, timely detection of arterial hypertension and awareness of Kaluga residents about possible consequences refusal to treat high blood pressure, it is planned to create health schools in 7 municipal outpatient clinics. Separate programs will be developed for teenagers. To equip rooms and conduct classes with patients, it is necessary to purchase video equipment, screens, and videos. Clinics should have stands on healthy lifestyles and prevention of complications of hypertension. Health schools will work according to unified programs that must be purchased at the centers for the prevention of cardiovascular diseases. Medical workers at health schools must undergo training at the existing center in Moscow. It is planned to publish booklets, magazines, and pressure diaries for school students.

To increase the availability of preventive blood pressure measurement, it is planned to purchase and install automatic blood pressure measurement devices with results in places where city residents frequently contact them for everyday needs (shops, pharmacies, large clinics). This will allow a person without signs of illness to know their blood pressure and promptly consult a doctor if they have high blood pressure.

The Kaluga city health department plans to create a website for the prevention of cardiovascular diseases. For project development and technical support, it is necessary to involve a specialist in the field of information technology.

In order to popularize a healthy lifestyle among medical workers, it is planned to hold competitions under the motto: “A healthy physician is a role model” and to hold a city conference “A healthy heart is the path to longevity.” The results of the conference and the results of the competition will be communicated to the general population of the city of Kaluga.

The program provides for the training and retraining of medical workers on the issues of treatment and early detection of cardiovascular pathology. For this purpose, 4 doctors from the Emergency Medical Care Hospital will undergo training in Moscow in cardiac surgery, 4 nurses will be sent to training courses to work on an angiosurgical unit. For clinics in 2009 and 2010. It is planned to train 2 cardiologists in the scope of primary specialization. In 2008 and 2009 2 cycles will be conducted for local internists and general practitioners with an expanded study of cardiology. In connection with the change in the procedure for providing medical care to patients with acute coronary pathology (widespread use of cardiac surgical methods of treatment for patients of working age with coronary heart disease), it is necessary to conduct a series of training seminars for medical workers of the emergency medical care station and the emergency department of the emergency hospital.

Early detection of coronary heart disease and prevention of myocardial infarction is possible with the use of modern diagnostic methods. To date informative method is cholera monitoring. The acquisition of such installations for clinics will make it possible to detect impaired vascular patency in the early stages and promptly carry out recanalization of cardiac vessels. The second necessary research method for identifying atherosclerotic vascular lesions in the early stages is the study of cholesterol in the blood serum. The presence of an express analyzer for determining cholesterol levels in every primary care physician will make it possible to develop individual programs combating atherosclerosis and its consequences.

Urban target Program it is planned to issue modern antihypertensive drugs persons of working age through local service primary care. This will create motivation for the population to see a doctor in the early stages of the disease and create an attitude towards the constant use of medications in the treatment of hypertension.

For effective fight with cardiovascular diseases, it is currently necessary to develop a new strategy for treating patients, including both drug treatment, as well as the widespread use of endovascular and surgical methods with an increase in their quantity and quality. Today, the possibility of performing thrombolysis and angioplasty in patients with acute myocardial infarction is limited; the situation is similar with regard to surgical care for patients with acute disorders of the blood supply to the heart. The cardiac surgery department at the emergency hospital will expand to 40 beds and be equipped with necessary equipment to provide emergency medical care to patients (tracking monitors, defibrillators, ventilators, consumables for stenting and balloon angioplasty). This will make it possible to provide timely, qualified, high-tech medical care to residents of Kaluga “on the spot” - in the cardiac surgery department of the emergency hospital without referral to Moscow clinics, and will make highly qualified, high-tech care more accessible to the population of Kaluga. Completing these tasks will significantly reduce the incidence of disease, improve the quality of life of those affected, and reduce mortality from this pathology.

Currently, up to 80 operations on recanalization of coronary vessels are performed per year on the basis of the cardiac surgery department; the adoption of this Program will triple this figure.

Patients who have suffered cerebrovascular accidents experience great difficulties due to the lack of rehabilitation centers. The patient has nowhere to turn to restore lost skills and functions as a result of a stroke, and the quality of life is sharply reduced. For further treatment of such patients, it is necessary to open two rehabilitation centers on the basis of the Kaluga City Hospital No. 5 and the Kaluga City Hospital No. 4 with rooms for mechanotherapy, paraffin treatment, ozokerite treatment, massage, physical therapy, hydropathic clinic. The maintenance of the staff of medical workers will be carried out at the expense of budget funds.

The city's target program provides for a wider use of after-care after acute myocardial infarction and heart surgery in sanatorium-resort conditions. For this purpose, inpatient medical institutions enter into agreements with the fund social insurance, which provides vouchers for sanatorium-resort treatment in cardiological sanatoriums.

Outside the scope of this city target Program, the solution to the issue of creating a unified vascular center in the city of Kaluga with the acquisition of computer and spiral tomographs, an angiographic unit, and the creation of a specialized neurosurgery department for vascular patients remains.

5. Feasibility study of the Program

____________________________

* The numbering of points is given in accordance with official text document. - Note "CODE".

6. Expected results of the Program implementation

1. Creation of an objective epidemiological picture of the incidence of arterial hypertension and dyslipidemia in Kaluga, increasing the number of people with a detected increase in blood pressure by 15%.

2. Reducing the number of days of disability from diseases of the circulatory system by 7-10%, disability as a result of strokes and heart attacks by 10-12%.

3. Reducing mortality from acute coronary and cerebral disorders by 8-12%, which corresponds to maintaining 250-350 human lives in year.

4. Reducing the level of hospitalization of people of working age for hypertension and its complications by 20%.

5. Transfer of the main activity of providing medical care to patients with arterial hypertension to the outpatient level, which will significantly reduce the costs of inpatient medical care.

6. Reducing ambulance calls to patients suffering from arterial hypertension by 5%.

7. Improving the quality and timeliness of medical care for cardiac patients, widespread introduction of interventional and cardiac surgical treatment methods.

7**. Improving the quality of life of patients who have suffered acute cerebrovascular accident.

____________________________

** Paragraph numbering is given in accordance with the official text of the document. - Note "CODE".

7. Consequences of the Program implementation and risk assessment of its implementation

The adoption of this city target Program will increase the number of cardiac surgeries by 2.5-3 times. High-tech, qualified assistance will be provided not only to planned patients, but also “acute” in the first hours of acute myocardial infarction, will prevent the development of irreversible changes in the heart muscle and heart vessels (left ventricular aneurysms, post-infarction occlusions of coronary vessels). The number of patients passing through the cardiac surgery department will triple, which, in turn, will reduce the mortality rate from acute coronary pathology in the city of Kaluga and significantly reduce the number of complications. The quality of life of patients and their ability to work will improve, and the number of disabled people will decrease. Planned and emergency patients will be examined (coronary angiography) as soon as possible and, if necessary, undergo surgical treatment- primary balloon angioplasty, stenting of coronary vessels. Currently, there is a gap between the initial examination of the coronary vessels (coronary angiography) and stenting, because Often after coronary angiography you have to wait to receive consumables and stents of the required sizes.

Primary stenting will save money consumables, contrast, do not re-irradiate cath lab personnel. Fewer patients will be sent for surgical care to the central institutes of Moscow, fewer patients will need very expensive open operations on the heart and coronary vessels (coronary artery bypass grafting, resection of cardiac aneurysms under the conditions of a heart-lung machine).

Will be unloaded cardiology departments hospitals "Pine Grove", therapeutic departments of the city and region.

The main consequence of the implementation of the Program will be the saving of 250-350 lives per year, which cannot be saved at present.

8. Management system and monitoring of the Program

The management of the city target Program will be carried out by the health department of the city of Kaluga. It is planned to hear the progress of the Program implementation twice a year at a meeting of the relevant committee of the City Duma of the Kaluga City District.

Monitoring the progress of the implementation of the target city Program will be carried out by the department for organizing medical care to the population on the basis of quarterly indicators.

Mortality from cardiovascular diseases continues to be the leading component in the overall mortality structure (up to 59%), with up to 91% of mortality caused by coronary heart disease and arterial hypertension and their complications in the form of acute myocardial infarction (AMI), heart failure (HF) . Every year, about 17 million people die from CVDs worldwide.

The development of CVD is not only a tragedy for every person, but also leads to enormous socio-economic damage due to significant costs for treatment and rehabilitation of patients.

In the USA, Canada, Germany, Belgium, France, Finland and some other countries, mortality from CVDs, incl. from IHD, tends to decrease. In countries of Eastern Europe, Russia and the CIS is determined by the growth of these indicators. According to the Russian State Committee on Statistics for 1998-2002. mortality from CVD increased by 21.9%, mortality from IHD - by 23.1%.

In Russia, CVD accounts for 55.4% of the mortality rate. Mortality from CVD is 90% determined by ischemic heart disease and myocardial infarction, only 10% by other types of pathology of the cardiovascular system.

In Uzbekistan, over the past two decades, there has been an increase in morbidity and mortality from cardiovascular pathology, and the structure of mortality does not differ from the world: the most significant reason Deaths are also diseases of the circulatory system (CVD) (59.3%).

Diseases of the cardiovascular system are one of the most important health problems in the republic. An analysis of the causes of mortality showed that mortality from cardiovascular diseases remains predominant in the structure of overall mortality, amounting to 79,120 people (56%) in 2005, 80,843 (57.9%) in 2006, and 80,843 (57.9%) in 2007. 80320 (58.4%), in 2008 - 82036 (59.1%), in 2009 - 79239 people (59.3%); and the main causes of mortality from cardiovascular diseases are coronary heart disease (CHD), arterial hypertension(AH) and cerebrovascular diseases (CVD), which account for at least 90% of all deaths from CVD. Mortality in working age is significantly higher among men, and among elderly and senile people it is almost the same, regardless of gender.

In order to increase public awareness of the danger caused by the epidemic of cardiovascular diseases in the world, as well as to initiate comprehensive preventive measures against coronary artery disease and cerebral stroke in all population groups, a new date has been introduced - World Heart Day, celebrated annually on the last Sunday of September, which was first organized in 1999 on the initiative of the World Heart Federation. This action was supported World organization Health (WHO), UNESCO and other significant organizations.

In partnership with WHO, the World Heart Federation organizes events in more than 100 countries, including health checks, organized walks, races and fitness classes, public lectures, performances, scientific forums, exhibitions, concerts, festivals and sports competitions.

World Heart Day is held annually to educate people around the world about:

1. That arterial hypertension, coronary heart disease (including myocardial infarction) and stroke are the leading causes of death worldwide;

2. That at least 80% of premature deaths from these diseases can be avoided if major risk factors such as smoking, poor diet and sedentary lifestyle are controlled.

The mission of the World Heart Federation is to help people around the world prolong and improve their lives by preventing the development of arterial hypertension, coronary heart disease and stroke, or actively controlling the course of these diseases. It includes members of 195 heart associations and foundations from more than 100 countries. In 2011 the motto " world day hearts" - "Heart for life."

On this day, the Republican Specialized Cardiology Center (RSCC) annually holds a charity event called “Open Doors Day”. In 2011, World Heart Day was held on September 30 under the motto: “Combating the main risk factors (RFs) for cardiovascular diseases, such as high blood pressure, increased level cholesterol in the blood, overweight, smoking, sedentary lifestyle." About 200 patients participated in this campaign. These risk factors lead to such serious diseases as coronary heart disease (heart attacks), cerebrovascular disease (stroke), high blood pressure (hypertension) , peripheral artery disease, rheumatic heart disease, and heart failure. Risk factors for coronary heart disease that cannot be changed include gender, age, and heredity. Risk factors that can be changed include: highest value have cigarette smoking, hypercholesterolemia and arterial hypertension, etc.

Currently, more than 200 different risk factors are known that influence the development of IHD. However, only in relation to 50-60 their real connection with the development of pathology has been established. For practice, a significantly smaller number of DFs is important. According to the WHO Expert Committee, the most important of them are:

Dyslipidemia (increased cholesterol levels and especially LDL cholesterol, low level HDL cholesterol, elevated triglycerides);
- AG;
- smoking;
- hyperglycemia;
- diabetes;
- obesity;
- low physical activity;
- hereditary predisposition;
- pathology of the blood coagulation system;
- psychosocial factors.

It has been proven that the presence of only one risk factor (hypertension, hypercholesterolemia or smoking) increases the likelihood of death over the next 10 years in men aged 50-59 years by 51%; the combination of hypertension with smoking or hypercholesterolemia increases this risk by 166%. Mortality from ischemic heart disease and acute cerebrovascular accident when all three of these factors are combined increases by more than 5 times. After a person develops signs of CVD associated with atherosclerosis, risk factors continue to act, contributing to the progression of the disease and worsening the prognosis.

Dyslipidemia

Lipid metabolism disorders, the main manifestation of which is an increase in the concentration of cholesterol in the blood (especially LDL cholesterol), are the main factor in the development of atherosclerosis and coronary artery disease. The results of numerous epidemiological studies have clearly shown that there is a direct relationship between cholesterol levels and the likelihood of developing coronary heart disease, especially myocardial infarction. It has been convincingly proven that lowering blood cholesterol levels significantly reduces the likelihood of developing new cases of the disease. It is estimated that a decrease in the concentration of cholesterol in the blood of just 1% in a population leads to a reduction in the risk of developing coronary artery disease in the population by 2.5%.

Obesity is one of the most common chronic diseases in the world. Obesity is now reaching pandemic proportions.

The results of epidemiological studies have revealed a clear connection between the increase in the prevalence of obesity and the increase in the incidence of CVD. The likelihood of developing these severe disabling diseases increases with increasing BMI and fat deposits in the abdominal-visceral area.

The impact of tobacco smoking on mortality rates should be noted. Every year, more than 5 million people around the world die from smoking-related causes. There is a clear connection between the number of cigarettes smoked and the incidence of CVD. Smoking has a particularly unfavorable effect on people who acquired this habit at a young age; at the same time, the life prognosis due to the fact that the negative effect on the body begins very early, and its duration is the longest, is the least favorable. According to some data, if a person smokes at 15 years old, his life expectancy decreases by more than 8 years, for those who start smoking at 25 years old and later - by 4 years. It is believed that in the United States alone, smoking is responsible for 325 thousand premature deaths annually.

The risk of developing CHD in smokers is 3.3 times, and the risk of death from CVD is 2-2.5 times higher than in non-smokers. There is a close relationship between the risk of developing coronary artery disease and the number of cigarettes smoked per day. For persons who smoke half a pack of cigarettes per day, the risk value is 1.6; more than one pack - 2.40. Smoking influences the occurrence and development of atherosclerosis and coronary artery disease in different ways: by reducing the level of HDL cholesterol, modifying LDL, which become more atherogenic.

According to some data, complete smoking cessation reduces the incidence of coronary artery disease in the population by 30%.

Alcohol consumption is one of the the most important factors risk of occurrence various diseases. Currently received as general grades the impact of alcohol abuse on people’s health, and assessments of certain species diseases and causes of death. According to WHO, mortality rates among alcoholics are 2-4 times higher than among the general population. If men most often die from cardiovascular diseases (in 75% of cases) over the age of 60, then men who abuse alcohol die from this cause mainly before the age of 60. There is no doubt that abuse sharply increases mortality in general and from coronary heart disease in particular. Alcohol can contribute to the development of coronary artery disease through other risk factors: increased blood pressure, body weight, and triglyceride levels in the blood. It was shown that among individuals who drank alcohol regularly, hyperlipidemia and myocardial infarction were more common than among those who did not drink alcohol or drank alcohol irregularly.

According to National Institute heart, lungs and blood of the United States, insulin-dependent diabetes mellitus in the elderly increases the risk of coronary artery disease by 3 times in men, and even higher in women. The frequency of impaired carbohydrate tolerance among patients with coronary artery disease, according to the results of studies by different authors, varies widely - from 29 to 76%, and hyperglycemia is considered as an unconditional risk factor.

The World Heart Federation has listed factors that provoke the development and worsening of cardiovascular diseases:

The main risk factor for normal heart function is poor nutrition. For many years, a person violates the correct regime, qualitative and quantitative characteristics of nutrition, and as a result has excess body weight and high risk development of heart attacks and strokes. Eating disorders in most cases are characterized by the abuse of excessively high-calorie foods, animal fats and simple carbohydrates; deficiency of vegetable oils in the diet, increased consumption table salt; power failure.

In addition to poor nutrition Often people suffer from physical inactivity, which, by exacerbating obesity, increases the risk of cardiovascular diseases. In conditions of physical inactivity, when a person does not perform necessary for the body the number of movements, the vessels cannot work correctly. As a result of such disorders, cholesterol deposits accumulate on the vessel wall and they become less elastic.

To maintain heart health you need to:

Abstinence from tobacco use: nicotine leads to sharp decline the amount of oxygen in the blood, which forces the heart to compensate for “oxygen hunger” by working harder. Vessels also suffer, in which the tone sharply decreases and throughput. Passive smoking also dangerous. The risk of heart attack or stroke begins to decline immediately after you stop using it. tobacco products, and in a year it can decrease by 50%. Do not allow smoking in the house. By quitting smoking, you will improve your health and the health of your loved ones. Set a rule: for every cigarette smoked, the smoker does additional housework.

Proper Diet: To maintain a healthy cardiovascular system, a balanced diet that includes a large number of fruits and vegetables, whole grains, lean meats, fish and legumes with limited intake of salt, sugar and fat. It has been proven that the abundance of fatty and salty foods in our diet not only causes obesity, but also has a bad effect on the elasticity of blood vessels, and this impairs blood flow. In addition, there are products that, while providing a tonic effect on the body, can directly affect the cardiovascular system. These include strong tea, coffee, and alcoholic drinks. All this, especially alcohol, should not be abused. Stick to principles healthy eating. Avoid fatty, fried and high-calorie foods.

Regular physical activity and maintaining optimal body weight: To maintain a healthy cardiovascular system, regular physical activity is necessary, at least half an hour daily. This includes sports, long walks in the fresh air, swimming, hiking, that is, any physical activity that gives a person pleasure. Hardening procedures will also be useful: this can be a contrast shower, dousing cold water or long walks in the fresh air, and everyone can find something they like. Such activities strengthen the walls of blood vessels and thereby prevent many serious illnesses. Rest should also be complete. The normal duration of sleep should be 8-10 hours a day, and it is better when you have the opportunity to rest during the day. Encourage physical activity. Limit the time you and your family spend watching TV and using the computer. Organize family outings, hikes and outdoor games.

Know your numbers - health indicators such as: High blood pressure in some cases is not accompanied by any symptoms, but can lead to a sudden stroke or heart attack. Check your blood pressure yourself, or ask a relative to help you, or visit medical institution, for example, the Health Center, where they will measure your blood pressure, determine your blood glucose and cholesterol levels, and calculate your body mass index. Knowing your risk for heart disease can help you develop a specific action plan to improve your heart health.

R. Kurbanov, director of the RSCC, professor. O. Urinov, researcher at RSCC.

Death statistics are rising. This is cold data. Is our negligent attitude towards health or an incorrect healthcare system to blame for this? Discuss with an expert

Photo: Dmitry POLUKHIN

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According to official data from the Ministry of Health, in the first quarter of 2015, mortality increased by more than 3 percent. It's a lot. Considering that new technologies are being actively introduced and a healthy lifestyle is endlessly advertised, these data are slightly discouraging. Yes, we can say that modern equipment there is no one to work - there are no personnel, there is a reduction in doctors and hospitals in the country, there is a constant shortage of nurses... But at the same time pharmaceutical industry, it would seem, is one step ahead of these negative aspects - in pharmacies you will be offered so many medications to choose from that it is simply impossible not to recover. True, for a lot of money, because the price of medicines is rising at some wild pace.

We discussed these and other questions with Doctor of Medical Sciences, Professor, Head of the Laboratory of the State Research Center for Preventive Medicine of the Ministry of Health of Russia Mehman Mamedov.

Is the system to blame?

- Mehman Niyazievich, in your opinion, is the ineffective work of managers of various ranks in the healthcare structure primarily to blame, or are there some other factors?

Called various reasons increase in population mortality. This is the ineffective work of territorial heads of health authorities, an unoptimized system of social benefits, insufficient drug provision and medical assistance, etc. In our opinion, if this phenomenon is widespread throughout the country. And it is necessary to analyze the situation more purposefully. It can be assumed that this trend is based on complex causes, including socio-economic factors.

- In Russia, as well as in other countries, cardiovascular diseases are in first place among the causes of mortality. Why is this happening - is it our fault or is it the disorganization of the healthcare system?

Every year, about 17.5 million people worldwide die from cardiovascular diseases (CVDs), primarily from complications of coronary heart disease (CHD). In terms of mortality from coronary heart disease, our country occupies one of the leading places. And, indeed, in the overall structure of mortality in Russia, more than 55 percent are complications of diseases of the cardiovascular system. According to Rosstat, in 2014, 64,548 people died from complications of CVD in Russia. This is 2-3 times more compared to road traffic accidents and infectious diseases.

But nevertheless, despite these sad data, over the past 15 years the diagnosis of cardiovascular diseases has improved in the country. A system of providing high-tech medical care to the population was introduced: 112 regional vascular centers and 348 primary vascular departments were created in 80 constituent entities of the Russian Federation. In all 85 regions, the formation of a three-level system of care for vascular patients has been completed, based on one center per 500 thousand population. In large cities, including Moscow, Krasnodar, Kemerovo, Perm, Novosibirsk, St. Petersburg, Tyumen, round-the-clock and accessible assistance is organized. This certainly reduces mortality from myocardial infarction and cerebral strokes. Recently, there have been some restrictions in the financing of high-tech medical care, but this is compensated by the growth of its volumes through the compulsory health insurance system.

The future of cardiology is prevention

- And yet this is not enough. Is the problem underfunding?

In the United States, 18% of GDP is spent on medical needs. According to American colleagues, if such rates of development are maintained, in the near future it will be necessary to spend more than 40% of US GDP on cardiac surgery. And the economy of no country can withstand this. In general, the future of cardiology is the prevention of diseases and their complications. Therefore, prevention of cardiovascular diseases is one of the most important and cost-effective methods of maintaining public health. I am glad that over the past two years the system of medical examination of the population has been restored throughout the country. Numerous health centers operate to identify risk factors in outpatient settings free of charge. This should greatly help identify and treat heart disease in the early stages.

Meanwhile, a set of measures for primary prevention provides for active work in the media, campaigns to popularize a healthy lifestyle among the population, medical examinations, including the departure of mobile teams to rural areas, achieving target levels of the main risk factors, in particular blood pressure control, cholesterol and sugar levels. Alas, so far in Russia these measures are clearly not enough.

- But in our country, a lot depends on the reluctance of people to go to doctors. So they drag it out until the last minute...

Agree. Our people have no commitment to a healthy lifestyle; they devote little effort and time to the prevention of diseases, including cardiovascular diseases. We have a whole network of health centers in our country, and a medical examination program has been launched. But do all the people who come voluntarily to learn about their health know about them? Most people turn to doctors only when the disease has already taken hold. In my opinion, as in the opinion of many regional healthcare leaders, this largely depends on the fact that there is no proper advertising of the fight against bad habits and healthy lifestyle. It is necessary to provide prime time for commercials on TV, radio and newspapers, as well as more street banners about a healthy lifestyle and disease prevention.

What will calm your heart...

- The President of Russia declared 2015 the year of the fight against cardiovascular diseases. Whether there is a national plan to reduce coronary heart disease?

To solve this problem, the President of the country emphasized the need to unite the efforts of medical workers, representatives of culture, education, media, public and sports organizations. And, by the way, there really is a successful experience of such joint efforts. For example, in Finland, which in the 70s had a high mortality rate from cardiovascular diseases. After the implementation of the “North Karelia” project, statistics from CVD and other socially significant complications decreased to 60%. If we talk about Russia, at the beginning of 2015, the Ministry of Health, together with a group of scientific experts, developed an action plan to reduce mortality from coronary heart disease (CHD), consisting of 4 blocks: prevention, secondary prevention, increasing the efficiency of medical care and constant monitoring of indicators . Each section contains at least 10 points. They will help improve the delivery of cardiac care.

- But difficulties clearly cannot be avoided...

Of course, in the implementation of a comprehensive plan, there are a number of difficulties associated not only with insufficient funding and the level of medical care, but also with unsatisfactory propaganda and motivation of the population to a healthy lifestyle, staffing of individual health care units, etc. In our opinion, the comprehensive implementation of these plans, even under conditions of moderate funding, can significantly reduce the morbidity and mortality from IHD. But this requires long-term work and effective control of the healthcare system.

A positive point is the fact that the Ministry of Health of the Russian Federation in the future until 2030 does not plan to reduce state guarantees of free medical care. However, according to the auditors of the Accounts Chamber of the Russian Federation for last year volume of paid medical services increased by more than 20%, which claims to replace free medical care with paid ones.

According to Deputy Prime Minister Olga Golodets, there are reserves for reducing the mortality rate of the population of the Russian Federation, in particular, in the area of ​​CVD treatment. According to her, the work of the healthcare system needs to be improved through proper organization, improved interaction with the population, advanced training, and the responsibility of doctors, which is what the reforms being carried out in the healthcare system are apparently aimed at.

On my own behalf, I can add that to effectively combat cardiovascular diseases, in particular coronary heart disease, an integrated approach is required in optimizing primary and secondary prevention. As well as rehabilitation, a control system at all levels of implementation federal programs and legislation, interaction between local medical and social services.

ONLY FACTS

In October 2014, the head of the Ministry of Health, Veronika Skvortsova, said that this year life expectancy in Russia was 71.6 years, which is 0.8 years more than in 2013.

IN different years Life expectancy in Russia was changing dynamically, it was like waves that were slowly but surely growing. But there were also downturns. For example, in the 70-80s of the XX century average duration The average lifespan of the population was 68-69 years; since 1990, there has been a decrease in this indicator to 65 years. And a repeated peak of its increase was registered in 2011, which amounted to 69.4 years.

According to the World Bank, in developed countries there is a trend towards a rapid increase in average life expectancy. For example, USA – 78.7 years, Japan – 83.1 years. Some developing countries are also rapidly overtaking us. In China, the average life expectancy is 75.2 years.