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Aim. To evaluate the effectiveness of a novel approach to follow-up monitoring of patients with lower extremity peripheral artery disease (PAD) using telemedicine technologies.Material and methods. The study included 175 patients (mean age, 68,1±7,7 years). Two following groups of patients were formed: the main group (n=86), which used an optimized monitoring program using telemedicine techniques, and the control group (n=89), which assumed traditional monitoring by a cardiologist and a vascular surgeon. The mean follow-up period was 11,77±1,5 months. The optimized monitoring program included the implementation of audio communication with patients by an employee with a secondary medical education with an assessment of the current health status according to original unified questionnaire, with the definition of personalized management tactics. At the primary and final stages, the patient underwent an assessment of clinical and anamnestic data, mental and cognitive status, and compliance.Results. At the final stage, uncompensated hypertension was revealed in 36,0% and 49,4% (p=0,0001), smoking — in 30,6% and 42,9% (p=0,05) in the main and control group, respectively. In the main group, a greater pain-free walking distance was revealed — 625,8±395,3 m (control group — 443±417 m (p=0,013)). The average systolic blood pressure was 125,2±10,2 mm Hg and 138,8±15,8 mm Hg (p=0,0001) in the main and control group, respectively. In the control group, a greater number of patients with a high level of personal and situational anxiety were revealed (p=0,05). In the main group, a higher level of adherence to therapy was established at the final study stage (p=0,001).Conclusion. The optimized monitoring program for patients with limited mobility is effective and can be implemented in practical healthcare for patients with lower extremity PAD.

Aim. Comparative analysis of life quality (LQ), psychological status and treatment adherence in patients before and after prevention events in local polyclinics.Material and methods. In the study, both gender persons participated (n=1082), age 21-70 y.o., registered as dispensary in the polyclinics of MBHI “Clinical Consulting-Diagnostical Center” of Kemerovo. During 6 months, two groups were followed up, comparable by the mean level of the main modifiable risk factors. Main group patients underwent primary risk measurement and further investigation with innovative approach to medical prevention, based on differential group training. All participants, before and after the prevention events were assessed for LQ, psychological status, treatment adherence.Results. In patients under dispensary follow up in local polyclinics, there were revealed: predominance of middle level of physical component and low level of psychological component of LQ; high level of chronic psychoemotional stress, anxiety and depression; high level of treatment adherence. The efficacy shown, of the performed prevention events. In intervention group there was significant positive dynamics almost in all scales of SF-36. Self-rating increased for the health self-evaluation and for treatment perspectives — GH (p=0,0001), psychoemotional background improved — RE (p=0,0001), social — SF (p=0,001) and life activity — VT (p=0,0089), the levels of situational and trait anxiety decreased (p=0,001 and p=0,0047 respectively), treatment adherence increased (p=0,00043).Conclusion. By the results of the study, the differences revealed in LQ, psychoemotional status and treatment adherence in the main patients group, who were managed with an innovative clinical organizational approach, and in comparison group. LQ of the main group patients by all SF-36 scales significantly improved, levels decreased of psychoemotional stress, anxiety and depression. Innovative methods of prevention work in local polyclinics facilitate improvement of LQ, patient’s responsibility for self-health care; shape rational and active attitude towards the disease, motivation to be healthier, treatment adherence and compliance to clinician recommendations.

Aim. To evaluate life quality (LQ), specifics of psychological state, level of adherence to treatment and prevention in the covered inhabitants of local outpatient primary institution (polyclinic).Material and methods. Totally, 1082 persons participated, age 21-70 y.o. and older, on dispensary coverage at MBHI “Clinical consulting and diagnostic center” of Kemerovo city. In all participants, the following were studied: prevalence of arterial hypertension, diabetes, hypercholesterolemia, smoking, waist circumference increase, developed coronary heart disease, LQ, adherence and anxiety levels.Results. Under the framework of aged-stratified dispanserization in local polyclinic, 272 males and 810 females investigated. Analysis of age-gender groups by the levels of physical, psychological health, reactive and trait anxiety, treatment adherence did not reveal significant differences. However, for all age groups there is a low level common, of physical and psychological health, and high mean levels of anxiety and treatment adherence. High levels of reactive and trait anxiety found in healthy men and women comparing to the diseased. In all patients in dispanserization, regardless of the presence or absence of disease, there is high treatment adherence.Conclusion. There are high levels found, in chronic psychoemotional stress, anxiety and depression, and adherence level is high in all groups of patients. This might witness on positive attitudes of patients to participation in prevention events and consulting, with the aim for risk factors correction, and decrease of cardiovascular diseases development probability, and in those alredy having such diseases, decrease of severity and complications rate. It is necessary to provide with psychological assistance for improvement of psychoemotional state and personal adaptation potential, level of LQ, for all covered by dispensary observation patients in territory polyclinics.

Aim. To assess the factors associated with combination cardio protection therapy intake in patients with atherosclerotic lesion of lower extremities. Material and methods. Totally, 436 patients studied: 372 (82,3%) males and 64 (14,7%) females at the age 45-81 (mediana 63) year old with obliteration atherosclerosis of lower extremities >50%. Patients were investigated under the framework of the registry in Kemerovo cardiological center in 2009-2013 y. The study included a dynamic follow-up of vascular surgeon and cardiologist, instrumental and laboratory investigation. Depending on the regularity of cardioprotection therapy, two groups were shaped: group 1 (n=226) taking full combination cardioprotection therapy: antiplatelets, inhibitors of angiotensin-converting enzyme or angiotensin receptor blockers and statins, group 2 (n=210) did not take at least one of the listed drug groups.Results. The intake of combination cardioprotection therapy was associated with higher prevalence of arterial hypertension (95,1%), myocardial infarction (46,5%), coronary bypass and percutaneous coronary intervention (21,1% and 32,3%, resp.), as interventions on extracranial arteries (12,8%). Patients from this group had angina presentation more often and the diagnosed coronary heart disease — 68,1% and 83,2%, resp. Almost 60% of patients with adequately prescribed treatment were followed-up by cardiologist. In laboratory data of this group there was lower level of total cholesterol. Patients had significantly larger left ventricle and lower ejection fraction.Conclusion. The factors associated with optimal medication treatment were ischemic heart disease (p

Aim. To evaluate the effectiveness of ambulatory secondary prevention among patients after myocardial infarction (MI). Material and methods. In total, 208 ambulatory medical histories of patients, examined at the cardiology dispanser and three polyclinics, were analysed. All patients, aged 45-75 years, previously had an MI, with or without Q wave (1 month — 1 year ago). In addition, all patients underwent clinical interview. Results. A very low level of non-pharmaceutical therapy compliance was observed. Every fourth cardiology dispanser patient and every second polyclinic patient were not compliant to dietary recommendations; 47 % and 35,2 %, respectively, had low physical activity, and every second male patient was a current smoker. Cardiology dispanser and polyclinic doctors prescribed anti-aggregants to 86 % and 75 % of their patients, respectively. For beta-adrenoblockers, the respective percentages were 86 % and 52,8 %, and for statins — 87 % and 21,3 %. Lipid profile assessment was regularly performed in 49 % of the cardiology dispanser patients. In 11 %, lipid profile was assessed irregularly, and in 40 % of the cases, only total cholesterol level was measured. Conclusion. The study results suggest low compliance of primary healthcare patients to non-pharmaceutical therapy. Polyclinic doctors demonstrated inadequate knowledge on pharmacotherapy potential in treating postMI patients.

The article presents an innovative clinico-organisational model of medical care in cardiovascular disease (CVD), functioning in a large industrial city. The model is based on the “closed circle” principle, including a unified ambulatory-outpatient system of cardiologic care and a multi-level hospital system of CVD healthcare: therapeutic cardiologic and high-technology surgical service, post-infarction and post-intervention rehabilitation, including sanatorium level. The base of the model is ambulatory service, uniting all city policlinic cardiologists at specialised municipal healthcare centres — cardiology dispansers, and functionally linked to other healthcare — specialised hospitals and sanatoriums. The “closed circle” system: policlinic — hospital — sanatorium — policlinic, facilitates consistency of patients’ treatment; accessibility and quality of healthcare; wide implementation of promising, cost-effective and high technology-based methods of diagnostics and treatment at ambulatory level; and effective use of expensive inpatient cardiosurgery resources. The new model is focused on CVD prevention, quality of life and demographics improvement, and working capacity maintenance in the population.