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Kalyuzhin VV, Teplyakov AT, Bespalova ID, Kalyuzhina EV, Terentyeva NN, Grakova EV, Kopeva KV, Usov VY, Garganeeva NP, Pavlenko OA, Gorelova YV, Teteneva AV. Promising directions in the treatment of chronic heart failure: improving old or developing new ones? BULLETIN OF SIBERIAN MEDICINE 2022. [DOI: 10.20538/1682-0363-2022-3-181-197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Unprecedented advances of recent decades in clinical pharmacology, cardiac surgery, arrhythmology, and cardiac pacing have significantly improved the prognosis in patients with chronic heart failure (CHF). However, unfortunately, heart failure continues to be associated with high mortality. The solution to this problem consists in simultaneous comprehensive use in clinical practice of all relevant capabilities of continuously improving methods of heart failure treatment proven to be effective in randomized controlled trials (especially when confirmed by the results of studies in real clinical practice), on the one hand, and in development and implementation of innovative approaches to CHF treatment, on the other hand. This is especially relevant for CHF patients with mildly reduced and preserved left ventricular ejection fraction, as poor evidence base for the possibility of improving the prognosis in such patients cannot justify inaction and leaving them without hope of a clinical improvement in their condition. The lecture consistently covers the general principles of CHF treatment and a set of measures aimed at inotropic stimulation and unloading (neurohormonal, volumetric, hemodynamic, and immune) of the heart and outlines some promising areas of disease-modifying therapy.
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Affiliation(s)
| | - A. T. Teplyakov
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
| | | | | | | | - E. V. Grakova
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
| | - K. V. Kopeva
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
| | - V. Yu. Usov
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
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Mareev YV, Gilarevsky SR, Begrambekova YL, Lopatin YM, Garganeeva AA, Duplyakov DV, Kobalava ZD, Golukhova EZ, Koziolova NA, Panov АV, Lelyavina ТА, Drapkina OM, Mareev VY. [Expert consensus regarding treatment of iron deficiency in stable and decompensated patients with heart failure]. ACTA ACUST UNITED AC 2021; 61:73-78. [PMID: 33998412 DOI: 10.18087/cardio.2021.4.n1639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022]
Abstract
In recent years there has been significant interest in treating iron deficiency (ID) in patients with heart failure (HF) due to its high prevalence and detrimental effects in this population. As stated in the 2020 Russain HF guidelines, Intravenous ferric carboxymaltose remains the only proven therapy for ID.This document was prompted by the results from the recent AFFIRM-AHF trial which demonstrates that treatment of ID after acute HF decompensation reduces the risk of future decompensations. Experts have concluded that in HF patients with acute decompensation, a left ventricular ejection fraction of < 50% and ID, Intravenous ferric carboxymaltose reduces future HF hospitalisations. Patients with stable HF may also benefit from treatment of ID to improve quality of life and alleviate symptoms. It is, therefore, reasonable to screen for and treat ID in patients with HF.
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Affiliation(s)
- Yu V Mareev
- National Medical Research Centre for Therapy and Preventive Medicine, Moscow, Russia Robertson Centre for Biostatistics, Glasgow, Great Britain
| | - S R Gilarevsky
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | - Yu L Begrambekova
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
| | - Yu M Lopatin
- Volgograd State Medical University, Volgograd, Russia
| | - A A Garganeeva
- Research Institute for Cardiology, Siberian State Medical University, Tomsk National Research Medical Center, Russian Academy of Sciences
| | - D V Duplyakov
- Samara Regional Clinical Cardiological Dispensary, Russia Samara State Medical University, Samara, Russia
| | - Zh D Kobalava
- Russian State University of Peoples' Friendship, Moscow, Russia
| | - E Z Golukhova
- Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
| | - N A Koziolova
- Perm State Medical University named after Academician E.A. Wagner, Perm, Russia
| | - А V Panov
- V.A. Almazov National Medical Research Center, Saint Petersburg, Russia
| | - Т А Lelyavina
- V.A. Almazov National Medical Research Center, Saint Petersburg, Russia
| | - O M Drapkina
- National Medical Research Centre for Therapy and Preventive Medicine, Moscow, Russia
| | - V Yu Mareev
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Russia
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Golukhova EZ, Kupryashov AA, Khicheva GA, Kuksina EV, Volkova OI, Kurilovich EO, Popovich LD. Socio-economic assessment of patient blood management practical implementation in surgical treatment of coronary heart disease (I20-I25). ACTA ACUST UNITED AC 2021; 61:77-86. [PMID: 33849423 DOI: 10.18087/cardio.2021.3.n1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/16/2021] [Indexed: 11/18/2022]
Abstract
Aim To evaluate possible social and economic benefits of correcting preoperative iron deficiency /iron deficiency anemia as a comorbidity in a model population in the process of transition from the routine practice to the optimized preparation of patients to elective surgery (as exemplified by several circulatory diseases: I20 - I25, class IX ICD 10).Material and methods By building imitation models depending on the patient blood management (PBM) practice, changes in years of life lost/saved adjusted for disability were evaluated, including in monetary terms, in relation to the annual number of operations performed for ischemic heart disease (IHD) (I20 - I25) in the age group of 17 years and older, as well as a potential effect of PBM on the applied health economics.Results With implementation of the PBM systemic measures in cardiac surgery, the potentially prevented annual social and economic damage will amount to more than 38 thousand years of life saved and more than 20.2 billion rubles in monetary terms. Furthermore, it will be possible to exclude 9435 hemotransfusion from the cardiosurgical practice, which will annually save more than 2.3 thousand liters of blood with a total cost of 77.7 million rubles in favor of clinical situations that have no alternative.Conclusion The implementation of PBM in cardiac surgery, the discipline with the highest levels of preoperative iron deficiency/anemia and the use of blood components, will not only improve the clinical outcomes and cost-effectiveness of surgical interventions, but will also prevent social and economic damage to the country.
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Affiliation(s)
- E Z Golukhova
- Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
| | - A A Kupryashov
- Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
| | - G A Khicheva
- Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
| | - E V Kuksina
- Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
| | - O I Volkova
- Institute of Health Economics, National Research University Higher School of Economics, Moscow, Russia
| | - E O Kurilovich
- Institute of Health Economics, National Research University Higher School of Economics, Moscow, Russia
| | - L D Popovich
- Institute of Health Economics, National Research University Higher School of Economics, Moscow, Russia
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